A clinically relevant MRI grading system for lumbar central canal stenosis

Yuan, Shiguo; Zou, Yong; Li, Yikai; Chen, Meixiong; Yue, Yong-Bin

doi:10.1016/j.clinimag.2016.07.005

Cited by 14 publications

(11 citation statements)

References 23 publications

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“…All measurements and classi cations were independently evaluated by 3 researchers. Interrater agreement was assessed using kappa coe cients as slight, fair, moderate, substantial and almost perfect [24]. All data are presented as the mean±standard deviation.…”

Section: Discussionmentioning

confidence: 99%

Definition, classification and morphometry of entrance of the bicipital groove and its associations with lesions of adjacent structures

Yuan

Zou

Zheng

et al. 2020

Preprint

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Background The definition of the entrance of the bicipital groove (EBG) is still unclear, and the relationships between the EBG and lesions of the long head of the biceps brachii tendon (LBT) and biceps pulley complex (BPC) have long been controversial. The purpose of this anatomic and imaging study was to define the EBG and to examine morphological parameters, classifications, and their relationships with lesions of the LBT and BPC. Methods One hundred thirteen unpaired intact dry humeri, 34 cadaveric shoulder specimens and 278 shoulder images were collected, measured, and classified based on morphological characteristics. Soft tissue and bony landmarks of the EBG were classified into different types. The relationships between the types and lesions of the LBT and BPC were analyzed through an anatomic and imaging study. Results Type II, type A and type i of the EBG and type b of the adjacent articular surface accounted for most of the dry humeri, cadavers, and images. Based on the EBG classification in the superoinferior image view, all of the subluxations and dislocations were classified as type B (61/120, 50.83%; χ2 = 16.55, P < 0.001), and most LBT and BPC lesions were type B (65/117, 55.56%; χ2 = 26.05, P < 0.001). LBTs were injured in (χ2=, P < 0.001) 83.56% of type B, 100% of type C, and 95.83% of type iii EBGs (χ2 = 135.69, 31.89, all P < 0.001). Similarly, BPCs were injured in 89.04% of type B and 93.10% of type C EBGs (χ2 = 153.14, P < 0.001), while BPCs were injured in 95.8% of type iii EBGs (χ2 = 33.79, P < 0.001). Conclusions The EBG is an anatomical concept worthy of clinical attention. Anatomical variations in the EBG correlated with lesions of the LBT and BPC. LBT and BPC lesions correlated with type B and C EBGs by imaging analysis.

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Section: Discussionmentioning

confidence: 99%

Definition, classification and morphometry of entrance of the bicipital groove and its associations with lesions of adjacent structures

Yuan

Zou

Zheng

et al. 2020

Preprint

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“…The correlation between radiological and clinical findings to distinguish between symptomatic and asymptomatic patients is, however, limited and unreliable for all common modalities such as X-ray, computed tomography, MRI scan or single-photon emission computed tomography (SPECT) scan [ 32 – 35 ]. This applies to both facet joint degeneration [ 36 , 37 ] and spinal stenosis, independent of whether quantitative [ 38 , 39 ] or qualitative stenosis classifications [ 40 ] are used. Clear correlations are usually described only for different parameters of the same technique: the occurrence of intraarticular fluid of the facet joints, for example, is known to increase with degenerative spondylolisthesis [ 41 , 42 ] and appears to be associated with lumbar instability [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Predictability of the effects of facet joint infiltration in the degenerate lumbar spine when assessing MRI scans

2017

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BackgroundImaging results are frequently considered as hallmarks of disease by spine surgeons to plan their future treatment strategy. Numerous classification systems have been proposed to quantify or grade lumbar magnetic resonance imaging (MRI) scans and thus objectify imaging findings. The clinical impact of the measured parameters remains, however, unclear. To evaluate the pathological significance of imaging findings in patients with multisegmental degenerative findings, clinicians can perform image-guided local infiltrations to target defined areas such as the facet joints.The aim of the present retrospective study was to evaluate the correlation of MRI facet joint degeneration and spinal stenosis measurements with improvement obtained by image-guided intraarticular facet joint infiltration.MethodsFifty MRI scans of patients with chronic lumbar back pain were graded radiologically using a wide range of classification and measurement systems. The reported effect of facet joint injections at the site was recorded, and a comparative analysis performed.ResultsWhen we allocated patients according to their reported pain relief, 27 showed no improvement (0–30%), 16 reported good improvement (31–75%) and 7 reported excellent improvement (> 75%). MRI features assessed in this study did, however, not show any relevant correlation with reported pain after facet joint infiltration: Values for Kendall’s tau ranged from τ = − 0.190 for neuroforaminal stenosis grading as suggested by Lee, to τ = 0.133 for posterior disc height as proposed by Hasegawa.ConclusionDespite the trend in evidence-based medicine to provide medical algorithms, our findings underline the continuing need for individualised spine care that, along with imaging techniques or targeted infiltrations, includes diagnostic dimensions such as good patient history and clinical examination to formulate a diagnosis.Trial registration ClinicalTrials.gov, NCT03308149, retrospectively registered October 2017Electronic supplementary materialThe online version of this article (10.1186/s13018-017-0685-x) contains supplementary material, which is available to authorized users.

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“…[5][6][7][8][9] Low back pain, radiculopathy or cauda equine syndrome are all symptoms identified in patients suffering from spinal stenosis, lumbar disc herniation or an intradural tumor compressing neural structures, such as the nerve roots, the conus medullaris or the spinal cord. [22][23][24] Acute or chronic presentations have also been reported, and they make the diagnosis possible when a specific dermatome is referred by the patient. However, when clinical symptoms cannot be fully explained by an identified disease, the coexistence of another spinal pathology should be considered.…”

Section: Palavras-chavementioning

confidence: 99%

Intradural Schwannoma Exacerbating the Symptoms of Degenerative Lumbar Stenosis: Case Report

et al. 2017

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Introduction Schwannoma is a common intradural slow-growing, benign and encapsulated tumor that originates from the myelin sheaths of the nerve fibers. However, a lumbar schwannoma complicating the symptoms of spinal stenosis is an extremely rare association. Aim To describe the case of a woman presenting a lumbar schwannoma in association with spinal stenosis. Case Report A 53 year-old female was referred to neurosurgical evaluation due to the worsening of a lumbar pain that was irradiating to the left inferior leg along the anterolateral surface. A neurological examination revealed motor deficits for extension of the left leg and attenuation of the left patellar reflex. Magnetic resonance imaging (MRI) showed lumbar spinal stenosis due to flavum ligament hypertrophy and disc herniation in the L3L4 and L4L5 segments, and an expansive lesion with homogeneous contrast enhancement occupying the left neuroforamen of the L3L4 segment. The patient underwent surgical resection of the tumor and decompression of the stenotic segments with posterior screw instrumentation from L3 to L5. She presented an uneventful recovery and significant improvement of the lumbar pain, and was still free of symptoms 6 months after surgery. An anatomopathological examination defined the tumor as a schwannoma (Grade I -World Health Organization [WHO]). Conclusion The present study highlights that lumbar schwannoma is a possible etiology complicating the symptoms of patients with previous lumbar spinal stenosis. It is important to treat both pathologies to improve the patients' symptoms.

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A clinically relevant MRI grading system for lumbar central canal stenosis

Cited by 14 publications

References 23 publications

Definition, classification and morphometry of entrance of the bicipital groove and its associations with lesions of adjacent structures

Definition, classification and morphometry of entrance of the bicipital groove and its associations with lesions of adjacent structures

Predictability of the effects of facet joint infiltration in the degenerate lumbar spine when assessing MRI scans

Intradural Schwannoma Exacerbating the Symptoms of Degenerative Lumbar Stenosis: Case Report

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