Clinical and MRI findings in lumbar spinal stenosis: baseline data from the NORDSTEN study

Abstract

Purpose The aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain. Methods The NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight. Results The percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm2) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (≥ 15°) 11.9%, degeneration of multifidus muscle (2–4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score. Conclusion In this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings. Trial registration www.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.

Role of Mri in the Diagnosis of Causes of Spinal Stenosis at Lumbosacral Region

“…The difference between study in gender and mean age depend on site of study in which population under review such as in Swedish study recorded mean age was 70 year and Nordsten study had mean age was 66 year [17].…”

“…Age consider a risk factors in evolution of lumbar spinal stenosis, variable study show various value of DSCA between participants depend on differences in age composition of studies, in Swedish study reported low cutoff value of DSCA which might also influence the result and most of study across section that study patients with complain in specific time period [17].…”

The association between preoperative MRI findings and clinical improvement in patients included in the NORDSTEN spinal stenosis trial

“…A significant association between Pfirrmann score and ODI score was detected, but with uncertain clinical relevance. [14].…”

“…The dichotomization of the scores in the different radiological classification systems was chosen to differentiate between patients with moderate and severe MRI changes and in concordance with earlier studies [12,14,21,24].…”

“…Radiological imaging is mandatory for establishing the LSS diagnosis and several radiological classification systems have been proposed, but their correlation to symptom severity is generally weak [12][13][14]. Previous studies evaluating the relationship between radiological findings and patient reported outcomes have reported conflicting results [15][16][17].…”