Anatomic radiological variations in developmental lumbar spinal stenosis: a prospective, control-matched comparative analysis

Kitab, Sameer A.; Alsulaiman, Ali M.; Benzel, Edward C.

doi:10.1016/j.spinee.2013.09.012

Cited by 27 publications

(36 citation statements)

References 40 publications

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“…The authors thus believe AP diameter to be a reliable indicator of spinal canal size. The quite recently introduced “reduced interlaminar angle” was proven to be a relevant measurement in the stenotic population in particular, however, was seen as less relevant in the current study population [37]. …”

Section: Discussionmentioning

confidence: 99%

Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients

et al. 2017

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IntroductionCorrelation between magnetic resonance imaging (MRI) and clinical features in cauda equina syndrome (CES) is unknown; nor is known whether there are differences in MRI spinal canal size between lumbar herniated disc patients with CES versus lumbar herniated discs patients without CES, operated for sciatica. The aims of this study are 1) evaluating the association of MRI features with clinical presentation and outcome of CES and 2) comparing lumbar spinal canal diameters of lumbar herniated disc patients with CES versus lumbar herniated disc patients without CES, operated because of sciatica.MethodsMRIs of CES patients were assessed for the following features: level of disc lesion, type (uni- or bilateral) and severity of caudal compression. Pre- and postoperative clinical features (micturition dysfunction, defecation dysfunction, altered sensation of the saddle area) were retrieved from the medical files. In addition, anteroposterior (AP) lumbar spinal canal diameters of CES patients were measured at MRI. AP diameters of lumbar herniated disc patients without CES, operated for sciatica, were measured for comparison.Results48 CES patients were included. At MRI, bilateral compression was seen in 82%; complete caudal compression in 29%. MRI features were not associated with clinical presentation nor outcome. AP diameter was measured for 26 CES patients and for 31 lumbar herniated disc patients without CES, operated for sciatica. Comparison displayed a significant smaller AP diameter of the lumbar spinal canal in CES patients (largest p = 0.002). Compared to average diameters in literature, diameters of CES patients were significantly more often below average than that of the sciatica patients (largest p = 0.021).ConclusionThis is the first study demonstrating differences in lumbar spinal canal size between lumbar herniated disc patients with CES and lumbar herniated disc patients without CES, operated for sciatica. This finding might imply that lumbar herniated disc patients with a relative small lumbar spinal canal might need to be approached differently in managing complaints of herniated disc. Since the number of studied patients is relatively small, further research should be conducted before clinical consequences are considered.

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Section: Discussionmentioning

confidence: 99%

Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients

et al. 2017

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“…This results in reduction of space available for accommodating neural contents, increasing not only the risk of developing stenotic symptoms, but also symptom recurrence requiring repeated surgery at other involved levels [8]. Previous studies comparing symptomatic patients who underwent surgery and asymptomatic individuals have noted that the anteroposterior (AP) bony spinal canal diameter is the most relevant magnetic resonance imaging (MRI) measurement associated with DSS [9].…”

Section: Introductionmentioning

confidence: 99%

The paradoxical relationship between ligamentum flavum hypertrophy and developmental lumbar spinal stenosis

et al. 2016

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BackgroundLigamentum flavum (LF) hypertrophy is a common cause of lumbar spinal stenosis and is thought to be degeneration-driven. Developmental spinal stenosis (DSS) is characterized by pre-existing narrowed spinal canals and is likely a developmental problem that occurs in childhood. In these cases, the LF may demonstrate different characteristics as compared to degeneration-driven stenosis. Thus, this study aimed to investigate the relationship between histological changes of LF and canal size.MethodsPatients who had surgical decompression for lumbar spinal stenosis were prospectively recruited and divided into three groups (critical DSS, relative DSS and non-DSS) based on previously defined anteroposterior bony spinal canal diameter measurements on MRI. The degree of disc degeneration and LF thickness were also measured from L1 to S1. Surgical LF specimens were retrieved for histological assessment of fibrotic grade and area of fibrosis.ResultsA total of 19 females and 15 males (110 LF specimens) with an overall mean age of 65.9 years (SD ± 9.8 years) were recruited. DSS was found to have a significant negative correlation (p < 0.001) with LF thickness, its fibrotic grade and area of fibrosis (%). Non-DSS exhibited a significant positive relationship with the degree of LF fibrosis. Disc degeneration and LF thickness had no correlation with LF histology.ConclusionsOur study is the first to definitively note that degeneration is the cause of LF fibrosis in non-DSS patients; however, in contrast, an inverse relationship exists between canal size and LF fibrosis in DSS patients, suggesting a different pathomechanism. Hence, despite a similar degree of LF thickness, DSS patients have LF with less fibrosis compared with non-DSS patients. Further investigation of the cause of LF changes in DSS is necessary to understand this relationship.

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“…prospektivno su pratili 66 bolesnika mlađih od 50 godina s perzistentnim simptomima koji su upućivali na stenozu spinalnog kanala i s kongenitalnom stenozom na magnetskoj rezonanciji (MR) u usporedbi s nalazom u bolesnika koji su imali pojedinačnu epizodu križobolje (kontrola). 35 Iako autori nisu našli razlike u incidenciji degenerativnih promjena i.v. diskova između dvije grupe, u glavnima promatranim ishodima (različite mjere za stenozu spinalnog kanala) bolesnici s kongenitalnim promjenama imali su teži stupanj stenoze i na više vertebralnih razina.…”

Section: Osnovna Funkcionalna I Topografska Anatomija Lumbosakralnog unclassified

“…Liječ Vjesn 2018;140: [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] Stenoza spinalnog kanala suženje je tog kanala s popratnim pritiskom na neurološke strukture, a najčešća je u području slabinske kralježnice. 1 Uzroci stenoze spinalnog kanala mogu biti različiti, ali ipak su najčešći uzrok degenerativne promjene.…”

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Lumbar Spinal Stenosis – From Epidemiology to Rehabilitation

2018

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Deskriptori: Spinalna stenoza-etiologija, dijagnoza, kirurgija, rehabilitacija; Slabinska kralješnica-anatomija, kirurgija, patologija; Fizioterapijski postupci; Kirurška dekompresija-metode; Spinalna fuzija-metode; Minimalno invazivni kirurški zahvati-metode Sažetak. Prevalencija stenoze spinalnog kanala slabinske regije u stalnom je porastu zbog starenja pučanstva. Naime, unatoč etiološkoj raznovrsnosti, ona najčešće nastaje kao posljedica degenerativnih promjena na kralježnici. Nema općeprihvaćene klasifi kacije stenoze spinalnog kanala slabinske regije. Za postavljanje dijagnoze potrebno je povezati nalaze iz anamneze, kliničkog statusa i slikovnih metoda zajedno s elektrofi ziološkim nalazima. Liječenje bolesnika sa stenozom spinalnog kanala slabinske regije može biti konzervativno (farmakološko i nefarmakološko) i kirurško, s tim da se u potonjem u posljednje vrijeme preferiraju minimalno invazivne tehnike. U ovom radu dajemo sveobuhvatni suvremeni pogled na stenozu spinalnog kanala slabinske regije.

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Anatomic radiological variations in developmental lumbar spinal stenosis: a prospective, control-matched comparative analysis

Cited by 27 publications

References 40 publications

Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients

Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients

The paradoxical relationship between ligamentum flavum hypertrophy and developmental lumbar spinal stenosis

Lumbar Spinal Stenosis – From Epidemiology to Rehabilitation

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