Prevalence and Definition of Multilevel Lumbar Developmental Spinal Stenosis

Abstract

Study Design: Cross-sectional study. Objectives: To define multilevel lumbar developmental spinal stenosis (DSS) using a composite score model and to determine its prevalence. Methods: This was a cohort study of 2385 openly recruited subjects with lumbosacral (L1-S1) MRIs. All subjects with previous spinal surgery or spinal deformities were excluded. The anteroposterior (AP) vertebral canal diameter was measured by two independent observers. Any associations between level-specific vertebral canal diameter and subject body habitus were analysed with non-parametric tests. Three or more stenotic levels, equivalent to a composite score of 3 or more, were considered as multilevel DSS. The median values of these subjects’ AP canal diameters were used to construct the multilevel DSS values. Receiver operating characteristic analysis was utilized to determine the ability of these cut-off values to screen for DSS by presenting their area under curve, sensitivity and specificity. Results: Subject body habitus was poorly correlated with AP vertebral canal diameter. Multilevel DSS was identified as L1<19 mm, L2<19 mm, L3<18 mm, L4<18 mm, L5<18 mm, S1<16 mm with 81%–96% sensitivity and 72%–91% specificity. The prevalence of multilevel DSS in this cohort was 7.3%. Conclusions: Utilizing a large homogeneous cohort, the prevalence of multilevel DSS is determined. Our cut-offs provide high diagnostic accuracy. Patients with multiple levels that fulfil these criteria may be at-risk of spinal canal compressions at multiple sites. Level of Evidence: III

Pilot study on lumbar canal diameter and walking distance in patients with lumbar spinal stenosis: a multivariate prediction model

“…De todos os pacientes recrutados, o número máximo de pacientes apresentou diâmetro mínimo do canal no nível de L5-S1, o que está altamente associado à literatura anterior, mostrando uma alta prevalência de estenose lombar no nível de L4-L5 e L5-S1. 18 Como as vértebras são anatomicamente mais anguladas no nível de L5-S1, há maior prevalência de degeneração por hipermobilidade. 19…”

The Modic‐endplate‐complex phenotype in cervical spine patients: Association with symptoms and outcomes

“…For example, developmental spinal stenosis may also contribute to the rise of other structural phenotypes, including facet joint degeneration, angulation irregularities, in addition to its narrowed canal. [37][38][39] These findings can further affect biomechanics and may induce additional degenerative changes, including the MEC. Indeed, multidimensional endplate abnormalities have been found to be associated with facet joint degeneration, 12 suggesting endplate pathology may be a marker in predisposed patients for other factors related to myelopathy.…”

Incidence and Skeletal Features of Developmental Cervical and Lumbar Spinal Stenosis

“…Myelopathy in DCSS [ 5 ] and cauda equina syndrome and radiculopathy in DLSS [ 6 ] are relatively common and frequently necessitate surgical treatment. However, few reports have investigated the prevalence of DCSS and DLSS [ 7 – 9 ].…”