Diagnosis of Lumbar Spinal Stenosis

Graaf, Irene de; Prak, Anneloes; Bierma-Zeinstra, Sita M A; Thomas, Siep; Peul, Wilco; Koes, Bart W.

doi:10.1097/01.brs.0000216463.32136.7b

Cited by 100 publications

(31 citation statements)

References 34 publications

(52 reference statements)

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“…The patients were all individually assessed and the chosen surgery was regarded as optimal for each patient [25, 26]. The intention was to release the pressure on nerve tissue by removing enough of the bone, facet joints and ligaments due to the compression.…”

Section: Methodsmentioning

confidence: 99%

Prognosis of Surgical Treatment for Degenerative Lumbar Spinal Stenosis: A Prospective Cohort Study of Clinical Outcomes and Health-Related Quality of Life Across Gender and Age Groups

Thornes¹,

Ikonomou²,

Grotle³

2011

TOORTHJ

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Degenerative lumbar spinal stenosis is a common condition and the most usual indication for spinal surgery in adult patients. The main objective of this study was to investigate clinical outcomes, health-related quality of life (HRQoL) and satisfaction among patients with a diagnosed lumbar spinal stenosis who were surgically treated, and whether these outcomes differed according to gender and age. Surgery was performed on 100 patients with clinical and radiological defined lumbar spinal stenosis. All patients completed questionnaires twice before surgery and at 6 weeks, 12 weeks, and 1 year postoperatively. Main outcomes were symptoms, physical function and patient satisfaction assessed by the Swiss Spinal Stenosis Questionnaire and HRQoL by the Short Form 36 health survey (SF36). There were large improvements in all clinical outcomes and in the physical subscales of the SF36. A marked reduction of average 32.3% was seen in symptoms already at 6 weeks follow-up. Physical function had improved with an average of 29.8% at 1-year follow-up. There was no statistical significant effect of age and gender on symptoms and physical function. Patients more than 65 years were significantly less satisfied at the 1-year follow-up as compared to the younger patients (p=0.012). This study showed that the majority of patients improved significantly in symptoms, physical function and physical HRQoL after surgery for degenerative lumbar spinal stenosis, regardless of age and gender. Age showed to be closely connected to satisfaction.

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Section: Methodsmentioning

confidence: 99%

Prognosis of Surgical Treatment for Degenerative Lumbar Spinal Stenosis: A Prospective Cohort Study of Clinical Outcomes and Health-Related Quality of Life Across Gender and Age Groups

Thornes¹,

Ikonomou²,

Grotle³

2011

TOORTHJ

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“…As a result, it makes sense to establish a Torg ratio for the lumbar spine that takes into account the AP diameter of the lumbar spinal canal and the AP diameter of the lumbar vertebral body. De Graaf et al [17] suggested that radiological studies have inherent inaccuracies, and this has been shown to be true by a number of radiological studies with conflicting conclusions [11, 12, 30–32]. Thus, a morphoanatomical study to establish a definite Torg ratio criterion for lumbar stenosis is warranted.…”

Section: Discussionmentioning

confidence: 99%

“…A review of the literature suggests that various estimates of the sensitivity and specificity of radiographic diagnosis of lumbar stenosis should be considered inaccurate due to the lack of an independent reference standard [11–17]. Exact measurements that define this condition are needed, as are simple parameters that will accurately predict if LSS is present.…”

Section: Introductionmentioning

confidence: 99%

Application of a correlation between the lumbar Torg ratio and the area of the spinal canal to predict lumbar stenosis: a study of 420 postmortem subjects

Bajwa

Toy

Ahn

2013

J Orthopaed Traumatol

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BackgroundA cervical Torg ratio of 0.8 has been used as a screening tool to determine the presence of cervical spinal stenosis. However, there have been no studies done to define the Torg ratio in the lumbar spine for predicting lumbar spinal stenosis (LSS). Torg ratios have never been correlated with the actual calculated canal area as derived from anatomic specimens. The aim of this study was to provide an analysis of the utility of the lumbar Torg ratio for predicting LSS based on objective measurements of skeletal specimens.Materials and methods420 adult skeletal specimens from the Hamann Todd Collection in the Cleveland Museum of Natural History were selected. Digital calipers were used to measure the sagittal diameter (SCD), interpedicular distance, pedicle length, and vertebral body diameter. The canal area at each level was calculated using a geometric formula. A standard distribution curve for canal area and Torg ratio was created, and values that were that is less than the mean minus two standard deviations (SD) below the mean were considered stenotic. Regression analysis was performed to determine if the Torg ratio was correlated with canal area, and if a “below normal” Torg ratio was predictive of LSS.ResultsThe Torg ratio for 2SD below the mean was defined as 0.43 at L1, 0.43 at L2, 0.41 at L3, 0.38 at L4, 0.37 at L5. Regression analysis revealed a significant association of the Torg ratio with canal area (p < 0.01). A Torg ratio that was less than the mean − 2SD predicted canal stenosis at L2, L3, L4, and L5 (p < 0.01). Using a Torg ratio of <0.5 predicted stenosis with a sensitivity of 86 % and specificity of 52 % at all lumbar levels.ConclusionsBased on the results of our study, we have defined the lower limit of the normal Torg ratio at each level. A Torg ratio of <0.5 predicts LSS and could be a useful radiological tool for LSS screening.

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“…Neurogenic claudication is defined as radiculopathy or pain and weakness in one or both lower extremities that worsen with walking and may be relieved with sitting or bending forward. [2627] MRI without gadolinium is considered the best imaging modality for diagnosing spinal stenosis. [272829] Specific measurements of spinal canal size on radiological imaging have not been shown to correlate with clinical symptoms of spinal canal stenosis.…”

Section: Lumbar Spinal Stenosismentioning

confidence: 99%

“…[2627] MRI without gadolinium is considered the best imaging modality for diagnosing spinal stenosis. [272829] Specific measurements of spinal canal size on radiological imaging have not been shown to correlate with clinical symptoms of spinal canal stenosis. However, a cross-sectional area of the dural sac of <110 mm 2 on MRI with can be useful in decision making for patients with clinically suspected lumbar stenosis.…”

Section: Lumbar Spinal Stenosismentioning

confidence: 99%

The Use of Imaging in Management of Patients with Low Back Pain

Rao

Scuderi²,

Scuderi

et al. 2018

Journal of Clinical Imaging Science

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Lower back pain (LBP) is one of the most common chief complaints encountered in primary care. Advanced imaging studies, including computerized tomography (CT) and magnetic resonance imaging (MRI), are frequently ordered in the setting of LBP. Structural abnormalities are commonly identified by CT and MRI in patients complaining of low back pain, however, these findings are also found in asymptomatic patients. In the past decade, multiple guidelines have been published to help providers identify patients in whom the use of advanced imaging is appropriate. In this article, we review common conditions associated with LBP that require advanced imaging along with their clinical and associated imaging findings.

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Diagnosis of Lumbar Spinal Stenosis

Abstract: Because of heterogeneity and overall poor quality, no firm conclusions about the diagnostic performance of the different tests can be drawn. Better-designed studies exploring the accuracy of diagnostic tests are needed to improve the diagnostic policy.

Cited by 100 publications

References 34 publications

Prognosis of Surgical Treatment for Degenerative Lumbar Spinal Stenosis: A Prospective Cohort Study of Clinical Outcomes and Health-Related Quality of Life Across Gender and Age Groups

Prognosis of Surgical Treatment for Degenerative Lumbar Spinal Stenosis: A Prospective Cohort Study of Clinical Outcomes and Health-Related Quality of Life Across Gender and Age Groups

Application of a correlation between the lumbar Torg ratio and the area of the spinal canal to predict lumbar stenosis: a study of 420 postmortem subjects

The Use of Imaging in Management of Patients with Low Back Pain

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