Qualitative Grading of Severity of Lumbar Spinal Stenosis Based on the Morphology of the Dural Sac on Magnetic Resonance Images

Schizas, Constantin; Theumann, Nicolas; Burn, Alexandre; Tansey, Rosamond J.; Wardlaw, Douglas; Smith, Francis W.; Kulik, Gerit

doi:10.1097/brs.0b013e3181d359bd

Cited by 525 publications

(399 citation statements)

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“…3 Multivariate logistic regression analysis of the factors influencing surgical decision making. Male sex, Oswestry Disability Index, morphological stenotic grades C and D, and motor weakness were independent predictors of a surgical decision for treating lumbar stenosis (the odds of the morphological stenotic grades C and D were described, compared to the next lower grade of stenosis, B and C, respectively) that there was no correlation between ODI and the radiologic stenotic grade in the present study and earlier studies [16,26], the morphological stenotic grade may independently influence the shared decision-making process, leading to surgery.…”

Section: Discussioncontrasting

confidence: 53%

“…The higher rate of lumbar surgery in women may not be attributed to preference but rather to their higher pain sensitivity and increased pain perception. Stenosis of the lumbar spine was radiologically graded using the method of Schizas et al [16]. Stenotic grade was significantly associated with the highest odds of a surgical decision.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, as expected, patients with motor weakness deficits had a tenfold higher chance of surgical treatment compared to those without it. The high odds ratios of morphological stenosis grades C and D and motor weakness for a surgical decision support the fact that the decision to proceed with surgery for LSS was primarily based on the morphology of the dural sac with motor weakness, even though it may be influenced by several other factors, such as clinical symptoms, finances, and access to health resources [16,25]. In addition, considering Fig.…”

Section: Discussionmentioning

confidence: 99%

“…The grading of canal stenosis was based on the cerebrospinal fluid (CSF)/rootlet ratio as seen on axial T2 images, according to the method by Schizas et al [16]. If the patient had canal stenosis at multiple levels, the most stenotic level was used for grading.…”

Section: Radiological Analysismentioning

confidence: 99%

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Factors influencing the surgical decision for the treatment of degenerative lumbar stenosis in a preference-based shared decision-making process

et al. 2014

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Introduction In a preference-based shared decision-making system, several subjective and/or objective factors such as pain severity, degree of disability, and the radiological severity of canal stenosis may influence the final surgical decision for the treatment of lumbar spinal stenosis (LSS). However, our understanding of the shared decision-making process and the significance of each factor remain primitive. In the present study, we aimed to investigate which factors influence the surgical decision for the treatment of LSS when using a preference-based, shared decisionmaking process. Methods We included 555 patients, aged 45-80 years, who used a preference-based shared decision-making process and were treated conservatively or surgically for chronic leg and/or back pain caused by LSS from April 2012 to December 2012. Univariate and multivariableadjusted logistic regression analyses were used to assess the association of surgical decision making with age, sex, body mass index, symptom duration, radiologic stenotic grade, Oswestry Disability Index (ODI), visual analog scale (VAS) scores for back and leg pain, Short Form-36 (SF-36) subscales, and motor weakness. Results In univariate analysis, the following variables were associated with a higher odds of a surgical decision for LSS: male sex; the VAS score for leg pain; ODI; morphological stenotic grades B, C, and D; motor weakness; and the physical function, physical role, bodily pain, social function, and emotional role of the SF-36 subscales. Multivariate analysis revealed that male sex, ODI, morphological stenotic grades C and D, and motor weakness were significantly associated with a higher possibility of a surgical decision. Conclusion Motor weakness, male sex, morphological stenotic grade, and the amount of disability are critical factors leading to a surgical decision for LSS when using a preference-based shared decision-making process.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Radiological Analysismentioning

confidence: 99%

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Factors influencing the surgical decision for the treatment of degenerative lumbar stenosis in a preference-based shared decision-making process

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“…It is true that we did not report, in that particular study, our surgical results. In our previous publication on the morphological grade (which included some of the surgical patients recorded in our latest study), we did report on clinical results and did not observe a relation between degree of stenosis and clinical result measured using the Oswestry Disability Index (ODI) [2]. Nevertheless, average ODI improved from 49 to 29 % after surgery in the surgical group.…”

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confidence: 74%

Authors’ reply to the Letter to the Editor of M. Melloh et al. concerning “Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis” (by PA Laudato et al. (2015) Eur Spine J; 24(10):2264–2268)

Schizas

Laudato

2016

Eur Spine J

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Incidence of Revision Surgery After Decompression With vs Without Fusion Among Patients With Degenerative Lumbar Spinal Stenosis

Ulrich

Burgstaller

Valeri³

et al. 2022

JAMA Netw Open

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IMPORTANCEOnly limited data derived from large prospective cohort studies exist on the incidence of revision surgery among patients who undergo operations for degenerative lumbar spinal stenosis (DLSS). OBJECTIVE To assess the cumulative incidence of revision surgery after 2 types of index operations-decompression alone or decompression with fusion-among patients with DLSS. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from a multicenter, prospective cohort study, the Lumbar Stenosis Outcome Study, which included patients aged 50 years or older with DLSS at 8 spine surgery and rheumatology units in Switzerland between December 2010 and December 2015. The follow-up period was 3 years. Data for this study were analyzed between October and November 2021. EXPOSURES All patients underwent either decompression surgery alone or decompression with fusion surgery for DLSS. MAIN OUTCOMES AND MEASURES The primary outcome was the cumulative incidence of revision operations. Secondary outcomes included changes in the following patient-reported outcome measures: Spinal Stenosis Measure (SSM) symptom severity (higher scores indicate more pain) and physical function (higher scores indicate more disability) subscale scores and the EuroQol Health-Related Quality of Life 5-Dimension 3-Level questionnaire (EQ-5D-3L) summary index score (lower scores indicate worse quality of life). RESULTS A total of 328 patients (165 [50.3%] men; median age, 73.0 years [IQR, 66.0-78.0 years])were included in the analysis. Of these, 256 (78.0%) underwent decompression alone and 72 (22.0%) underwent decompression with fusion. The cumulative incidence of revisions after 3 years of follow-up was 11.3% (95% CI, 7.4%-15.1%) for the decompression alone group and 13.9% (95% CI, 5.5%-21.5%) for the fusion group (log-rank P = .60). There was no significant difference in the need for revision between the 2 groups over time (unadjusted absolute risk difference, 2.

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Qualitative Grading of Severity of Lumbar Spinal Stenosis Based on the Morphology of the Dural Sac on Magnetic Resonance Images

Abstract: The grading defines stenosis in different subjects than surface measurements alone. Since it mainly considers impingement of neural tissue it might be a more appropriate clinical and research tool as well as carrying a prognostic value.

Cited by 525 publications

References 19 publications

Factors influencing the surgical decision for the treatment of degenerative lumbar stenosis in a preference-based shared decision-making process

Factors influencing the surgical decision for the treatment of degenerative lumbar stenosis in a preference-based shared decision-making process

Authors’ reply to the Letter to the Editor of M. Melloh et al. concerning “Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis” (by PA Laudato et al. (2015) Eur Spine J; 24(10):2264–2268)

Incidence of Revision Surgery After Decompression With vs Without Fusion Among Patients With Degenerative Lumbar Spinal Stenosis

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