Redefining lumbar spinal stenosis as a developmental syndrome: an MRI-based multivariate analysis of findings in 709 patients throughout the 16- to 82-year age spectrum

Kitab, Sameer A.; Lee, Bryan S.; Benzel, Edward C.

doi:10.3171/2018.5.spine18100

Cited by 20 publications

(21 citation statements)

References 43 publications

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“…identified in a cross-sectional population study that approximately 80% of participants older than 40 years had at least moderate and 31% had severe radiographic evidence of LCS. [ 9 10 ] The exact degree of intensity of clinical symptoms and the number of patients subjected to surgical treatment varies widely in various reports.…”

Section: Discussionmentioning

confidence: 99%

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Lumbar canal stenosis in “young” - How does it differ from that in “old” - An analysis of 116 surgically treated cases

Goel

Bhambere

Shah

et al. 2021

J Craniovert Jun Spine

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Objective: Patients treated for lumbar canal stenosis (LCS) were retrospectively analyzed to evaluate the differences in clinical management in those below (Group A) and those above (Group B) the age of 50 years. All patients were treated with the premise that instability is the nodal point of the pathogenesis of LCS and “only-stabilization” is the surgical treatment. Materials and Methods: During the period June 2014 to June 2020, 116 cases were diagnosed to have LCS and surgically treated by the Goel modification of Camille's transarticular screw fixation technique. Results: Twenty-four patients in Group A and six patients in Group B had a history of “significant” injury to the back at the onset of clinical symptoms. The indices suggested that the intensity of symptoms was relatively more severe in Group A than in Group B. Unilateral leg symptoms were more common in Group A (68%) than in Group B (31.8%). Neurological motor deficits were more common in Group A (28%) than in Group B (12%) patients. Spinal segments surgically treated in Group A ranged from 1 to 4 (average 2 levels) and in Group B it ranged from 2 to 5 (average 3 levels). During the follow-up period that ranged from 6 to 72 months (average 37 months), 100% of patients had varying degrees of relief from symptoms. Conclusions: LCS is confined to a lesser number of spinal segments in the Group A patients. The symptoms were radicular in nature and relatively severe in Group A than in Group B patients.

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Section: Discussionmentioning

confidence: 99%

“…Bone dysplasia and genetic aberrations have been considered to be possible etiological factors, particularly in younger patients. [ 9 10 11 12 ]…”

Section: Discussionmentioning

confidence: 99%

Lumbar canal stenosis in “young” - How does it differ from that in “old” - An analysis of 116 surgically treated cases

Goel

Bhambere

Shah

et al. 2021

J Craniovert Jun Spine

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“…Wada et al 20 noted improvement in the area of the dural tube at the level of compression to 408% after endoscopic decompression. Due to its excellent interobserver reliability and usage in the published literature, we utilized the Schizas qualitative measure, 11,17,18 rather than quantitative measures such as dural sac cross-sectional area or stenosis ratio, to measure central stenosis on MRI.…”

Section: Discussionmentioning

confidence: 99%

Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

Khalsa

Kim

Singh

et al. 2019

Neurosurgical Focus

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OBJECTIVELumbar central stenosis can theoretically be decompressed with minimal bone removal via an endoscopic approach. Although multiple studies have demonstrated an adequate radiographic decompression, none has quantified the volume of bone removal after endoscopic decompression. The objective of this study was to quantify the 3D volume of bone removed from the lamina and facet joints during endoscopic decompression for lumbar central and lateral recess stenosis.METHODSThis retrospective study included adults with lumbar spinal stenosis who underwent endoscopic decompression of a single level or 2 noncontiguous lumbar levels. Central stenosis on MRI was graded preoperatively and postoperatively using the Schizas scale. A computer program was developed in MATLAB to semiautomatically perform a 3D volumetric analysis of preoperative and postoperative lumbar CT scans. The volumetric percentage of bone removed from the lamina and facet joints ipsilateral and contralateral to the side of approach was quantified.RESULTSNineteen patients with 21 treated lumbar levels were included in the study. Preoperatively, the number of levels with Schizas stenosis grades B, C, and D were 5, 12, and 4, respectively. Stenosis grades improved postoperatively to grades A, B, C, and D for 17, 3, 1, and 0 levels, respectively. All levels improved by at least 1 stenosis grade. The volumetric percentage of laminar bone removed was 15.5% (95% CI 11.2%–19.8%, p < 0.001) from the ipsilateral lamina and 8.8% (95% CI 5.7%–11.8%, p < 0.001) from the contralateral lamina. The percentage of facet joint resection was 5.3% (95% CI 4.2%–6.4%, p < 0.001) and 4.3% (95% CI 2.2%–6.4%, p < 0.001) for the ipsilateral and contralateral facet joints, respectively. Average pain scores, as measured by the visual analog scale, improved from 7.9 preoperatively to 2.2 by 3–10 months postoperatively (p < 0.001).CONCLUSIONSEndoscopic lumbar decompression achieves improvement in the radiographic grade of lumbar central stenosis with minimal bone removal from the lamina and facet joints. Future prospective studies are needed to validate the findings of this study with more comprehensive clinical outcomes.

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“…More previous studies prefer MRI because it is safer and does not involve any radiation. However, the pathogenesis of degenerative LSS and developmental LSS differ [1]. Degeneration of the lumbar intervertebral disc, hypertrophy of the articular process and the calcification of ligamentum flavum are the main causes of degenerative LSS; treatment for patients is usually lumbar decompression.…”

Section: Introductionmentioning

confidence: 99%

Automatic Lumbar Spinal CT Image Segmentation With a Dual Densely Connected U-Net

et al. 2020

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The clinical treatment of degenerative and developmental lumbar spinal stenosis (LSS) is different. Computed tomography (CT) is helpful in distinguishing degenerative and developmental LSS due to its advantage in imaging osseous and calcified tissues. However, boundaries of the vertebral body, spinal canal and dural sac have low contrast and are hard to identify in a CT image, so the diagnosis depends heavily on the knowledge of expert surgeons and radiologists. In this paper, we develop an automatic lumbar spinal CT image segmentation method to assist LSS diagnosis. The main contributions of this paper are as follows: 1) a new lumbar spinal CT image dataset is constructed that contains 2393 axial CT images collected from 279 patients, with the ground truth of pixel-level segmentation labels; 2) a dual densely connected U-shaped neural network (DDU-Net) is used to segment the spinal canal, dural sac and vertebral body in an end-to-end manner; 3) DDU-Net is capable of segmenting tissues with large scale-variant, inconspicuous edges (e.g., spinal canal) and extremely small size (e.g., dural sac); and 4) DDU-Net is practical, requiring no image preprocessing such as contrast enhancement, registration and denoising, and the running time reaches 12 FPS. In the experiment, we achieved state-of-the-art performance on the lumbar spinal image segmentation task. We expect that the technique will increase both radiology workflow efficiency and the perceived value of radiology reports for referring clinicians and patients. INDEX TERMS Computed tomography, computer aided diagnosis, artificial neural networks, image segmentation.

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Redefining lumbar spinal stenosis as a developmental syndrome: an MRI-based multivariate analysis of findings in 709 patients throughout the 16- to 82-year age spectrum

Cited by 20 publications

References 43 publications

Lumbar canal stenosis in “young” - How does it differ from that in “old” - An analysis of 116 surgically treated cases

Lumbar canal stenosis in “young” - How does it differ from that in “old” - An analysis of 116 surgically treated cases

Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

Automatic Lumbar Spinal CT Image Segmentation With a Dual Densely Connected U-Net

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