Lumbar spinal stenosis: A review of current concepts in evaluation, management, and outcome measurements

Fritz, Julie M.; Delitto, Anthony; Welch, William C.; Erhard, Richard E.

doi:10.1016/s0003-9993(98)90048-x

Cited by 179 publications

(135 citation statements)

References 82 publications

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“…Since the degree of constriction of the spinal canal considered to be symptomatic for LSS is not clear, the diagnostic accuracy of imaging techniques, findings from clinical examination and appropriate outcome measures need to be identified to ensure careful patient and treatment selection for successful and lasting results. These questions warrant attention to improve the management of patients with LSS [9,19].…”

Section: Discussionmentioning

confidence: 99%

“…The sensitivity and specificity of magnetic resonance (MR) imaging for assessing individuals with LSS are reported to be higher than those of competing methods, with MR imaging outperforming computed tomography and myelography [9]. Measurements of the cross-sectional area of the dural sac are considered more effective in diagnosing central stenosis than measurements of the osseous spinal canal [25].…”

mentioning

confidence: 99%

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Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR Imaging

et al. 2008

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR Imaging

et al. 2008

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“…The etiologies of disability in patients with degenerative lumbar spondylolisthesis are multifactorial, and include mechanical factors such as spinal instability, neurological compromise, chemical factors, and other factors such as discogenic pain, facet arthropathy, and myofascial pain from ligaments or paraspinal muscles, etc. [8]. Therefore, it is very important for us to detect the critical factors affecting disability or physical functioning in degenerative spondylolisthesis.…”

Section: Discussionmentioning

confidence: 99%

“…The etiologies of disability are multifactorial in degenerative lumbar spondylolisthesis; the leading factors responsible for disability are spinal instability and neurological compromise [8]. Other pathological factors associated with disabilities in patients with degenerative lumbar spondylolisthesis include chemical factors such as inflammation, discogenic pain, facet arthropathy, and myofascial pain from ligaments or paraspinal muscles [8].…”

Section: Introductionmentioning

confidence: 99%

“…Other pathological factors associated with disabilities in patients with degenerative lumbar spondylolisthesis include chemical factors such as inflammation, discogenic pain, facet arthropathy, and myofascial pain from ligaments or paraspinal muscles [8]. Detection of the relevant factors associated with disability or physical functioning in degenerative spondylolisthesis is very important.…”

Section: Introductionmentioning

confidence: 99%

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Factors affecting disability and physical function in degenerative lumbar spondylolisthesis of L4–5: evaluation with axially loaded MRI

et al. 2009

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Few studies have investigated the factors related to the disability and physical function in degenerative lumbar spondylolisthesis using axially loaded magnetic resonance imaging (MRI). Therefore, we aimed to investigate the effect of axial loading on the morphology of the spine and the spinal canal in patients with degenerative spondylolisthesis of L4-5 and to correlate morphologic changes to their disability and physical functions. From March 2003 to January 2004, 32 consecutive cases (26 females, 6 males) with degenerative L4-5 spondylolisthesis, grade 1-2, intermittent claudication, and low back pain without sciatica were included in this study. All patients underwent unloaded and axially loaded MRI of the lumbosacral spine in supine position to elucidate the morphological findings and to measure the parameters of MRI, including disc height (DH), sagittal translation (ST), segmental angulation (SA), dural sac cross-sectional area (DCSA) at L4-5, and lumbar lordotic angles (LLA) at L1-5 between the unloaded and axially loaded condition. Each patient's disability was evaluated by the Oswestry Disability Index (ODI) questionnaire, and physical functioning (PF) was evaluated by the Physical Function scale proposed by Stucki et al. (Spine 21:796-803, 1996). Three patients were excluded due to the presence of neurologic symptoms found with the axially loaded MRI. Finally, a total of 29 (5 males, 24 females) consecutive patients were included in this study. Comparisons and correlations were done to determine which parameters were critical to the patient's disability and PF. The morphologies of the lumbar spine changed after axially loaded MRI. In six of our patients, we observed adjacent segment degeneration (4 L3-L4 and 2 L5-S1) coexisting with degenerative spondylolisthesis of L4-L5 under axially loaded MRI. The mean values of the SA under pre-load and post-load were 7.14°a nd 5.90°at L4-L5 (listhetic level), respectively. The mean values of the LLA under pre-load and post-load were 37.03°and 39.28°, respectively. There were significant correlations only between the ODI, PF, and the difference of SA, and between PF and the post-loaded LLA. The changes in SA (L4-L5) during axial loading were well correlated to the ODI and PF scores. In addition, the LLA (L1-L5) under axial loading was well correlated to the PF of patients with degenerative L4-L5 spondylolisthesis. We suggest that the angular instability of the intervertebral disc may play a more important role than neurological compression in the pathogenesis of disability in degenerative lumbar spondylolisthesis.

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Neurogenic Claudication: Nonoperative Management

Ammendolia

2011

Evidence‐Based Orthopedics

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Lumbar spinal stenosis: A review of current concepts in evaluation, management, and outcome measurements

Cited by 179 publications

References 82 publications

Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR Imaging

Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR Imaging

Factors affecting disability and physical function in degenerative lumbar spondylolisthesis of L4–5: evaluation with axially loaded MRI

Neurogenic Claudication: Nonoperative Management

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