Roentgenographic and computed tomographic findings in symptomatic lumbar foraminal stenosis

Yamada, Katsutaka; Aota, Yoichi; Higashi, Takayuki; Ishida, Ko; Niimura, Takanori; Konno, Tomoyuki; Saito, T.

doi:10.1007/s00586-014-3683-2

Cited by 19 publications

(7 citation statements)

References 22 publications

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“…Disc herniation is the most common cause of nerve root impingement when a structural correlate is identified (80-89%). Other causes may include synovial cyst formation, facet joint overgrowth, and spondylolisthesis with segmental instability [95,96]. Additionally, nerve tissue alterations can lead to both nociceptive and neuropathic pain.…”

Section: Dimension 5: Putative Pain Mechanismsmentioning

confidence: 99%

“…Acute lumbosacral radicular pain may arise following an inciting event that causes mechanical or inflammatory injury or from entrapment related to disc herniation or foraminal stenosis but does not result in conduction blockade, as with lumbosacral radiculopathy [94]. As with acute lumbosacral radiculopathy, disc herniation is the most common cause of nerve root impingement when a structural correlate is identified (80-89%), and other causes may include synovial cyst formation, facet joint overgrowth [95], spondylolisthesis with segmental instability [96], and chemical irritation from intradiscal inflammatory mediators [82]. In acute lumbosacral radicular pain, the underlying mechanism has features of both an inflammatory and neuropathic response.…”

Section: Dimension 5: Putative Pain Mechanismsmentioning

confidence: 99%

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AAAPT Diagnostic Criteria for Acute Low Back Pain with and Without Lower Extremity Pain

et al. 2020

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Objective Low back pain is one of the most common reasons for which people visit their doctor. Between 12% and 15% of the US population seek care for spine pain each year, with associated costs exceeding $200 billion. Up to 80% of adults will experience acute low back pain at some point in their lives. This staggering prevalence supports the need for increased research to support tailored clinical care of low back pain. This work proposes a multidimensional conceptual taxonomy. Methods A multidisciplinary task force of the ACTTION-APS-AAPM Pain Taxonomy (AAAPT) with clinical and research expertise performed a focused review and analysis, applying the AAAPT five-dimensional framework to acute low back pain. Results Application of the AAAPT framework yielded the following: 1) Core Criteria: location, timing, and severity of acute low back pain were defined; 2) Common Features: character and expected trajectories were established in relevant subgroups, and common pain assessment tools were identified; 3) Modulating Factors: biological, psychological, and social factors that modulate interindividual variability were delineated; 4) Impact/Functional Consequences: domains of impact were outlined and defined; 5) Neurobiological Mechanisms: putative mechanisms were specified including nerve injury, inflammation, peripheral and central sensitization, and affective and social processing of acute low back pain. Conclusions The goal of applying the AAAPT taxonomy to acute low back pain is to improve its assessment through a defined evidence and consensus-driven structure. The criteria proposed will enable more rigorous meta-analyses and promote more generalizable studies of interindividual variation in acute low back pain and its potential underlying mechanisms.

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Section: Dimension 5: Putative Pain Mechanismsmentioning

confidence: 99%

Section: Dimension 5: Putative Pain Mechanismsmentioning

confidence: 99%

AAAPT Diagnostic Criteria for Acute Low Back Pain with and Without Lower Extremity Pain

et al. 2020

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“…Severe central stenosis was defined by a surface area < 70mm², a moderate stenosis by a surface between 70 and 100 mm² (16)(17)(18). Foraminal stenosis was defined on sagittal slices by a cranio-caudal or antero-posterior diameter of the foramen < 4mm (19)(20)(21)(22). Foraminal width was defined by the antero-posterior maximum dimension between the inferoposterior wall of the vertebra and the top of the superior facet of the lower vertebra.…”

Section: Data Collectionmentioning

confidence: 99%

Do Curve Characteristics Influence Stenosis Location and Occurrence of Radicular Pain in Adult Degenerative Scoliosis?

et al. 2019

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Study design. Retrospective cohort Objective. The aim of this study was to describe the various locations of spinal stenosis (LSS) in lumbar scoliosis (DLS) and its related clinical symptoms. Introduction. Adult with lumbar scoliosis often present with pain and disability. Association of scoliosis and stenosis is not rare, but remains sparsely explored. Consequences of scoliosis on stenosis location and treatment remain debated. Methods. Patients operated for symptomatic LSS with DLS (Cobb angle>20°) from 2015 to 2016 were included. All patients completed preoperative clinical and neurologic exam. Coronal and sagittal radiographic parameters, rotatory subluxation (RS) and spondylolisthesis were analyzed on fullspine x-rays. CT-scan multiplanar reconstructions were performed to measure central, foraminal and lateral recess stenosis stenosis, from T10 to Sacrum.Results. 76 patients were included (69±9 years old, 77% female). 60% had neurogenic claudication, L5 was the most common radicular pain (41%). Mean Cobb angle was 33±16°. 35 (46%) patients had coronal malalignment; in 69%, side of the coronal tilt corresponded to side of the concavity of the lumbosacral curve. 60 patients had RS (most frequent level L3L4). In 50% of the cohort, RS was located at junction between lumbar and lumbosacral curves. In 70% (n=53) of the patients, central stenosis occurred at junction between lumbar and lumbosacral curve. Foraminal and lateral stenosis were most frequently observed in the concavity of the distal lumbo-sacral curve. L5 radicular pain was significantly more frequent in case of lumbo-sacral contra-curve and right coronal malalignment.Conclusion. LSS is frequent in DLS. Relationships exist between curve characteristics and symptomatic LSS in DLS; especially, concavity of the lumbosacral contra-curve and the junctional level between lumbar curve and lumbosacral contra-curve and. Therefore, accurate analysis of stenosis in ASD seems mandatory, to at least performed decompression; since, perfect planned treatment for stenosis and scoliosis correction might not be always performed, due to patient general health status.Level 4

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“…Although several studies have assessed LFS on CT (7–9), to our knowledge, there has been no study of intermodality agreement of MDCT and MRI for assessment of LFS. Therefore, the purpose of this study was to determine intermodality, inter-, and intra-observer agreement for assessment of LFS on MDCT and MRI.…”

Section: Introductionmentioning

confidence: 99%

Is multidetector computed tomography comparable to magnetic resonance imaging for assessment of lumbar foraminal stenosis?

et al. 2016

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Background Both multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are used for assessment of lumbar foraminal stenosis (LFS). Therefore, it is relevant to assess agreement between these imaging modalities. Purpose To determine intermodality, inter-, and intra-observer agreement for assessment of LFS on MDCT and MRI. Material and Methods A total of 120 foramina in 20 patients who visited our institution in January and February 2014 were evaluated by six radiologists with different levels of experience. Radiologists evaluated presence and severity of LFS on sagittal CT and MR images according to a previously published LFS grading system. Intermodality agreement was analyzed by using weighted kappa statistics, while inter- and intra-observer agreement were analyzed by using intraclass correlation coefficients (ICCs) and kappa statistics. Results Overall intermodality agreement was moderate to good (kappa, 0.478-0.765). In particular, two professors and one fellow tended to overestimate the degree of LFS on CT compared with MRI. For inter-observer agreement of all six observers, ICCs indicated excellent agreement for both CT (0.774) and MRI (0.771), while Fleiss' kappa values showed moderate agreement for CT (0.482) and MRI (0.575). There was better agreement between professors and fellows compared with residents. For intra-observer agreement, ICCs indicated excellent agreement, while kappa values showed good to excellent agreement for both CT and MRI. Conclusion MDCT was comparable to MRI for diagnosis and assessment of LFS, especially for experienced observers. However, there was a tendency to overestimate the degree of LFS on MDCT compared with MRI.

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Roentgenographic and computed tomographic findings in symptomatic lumbar foraminal stenosis

Abstract: A large segmental range of motion in sagittal plane of L5-S1 and posterior instability of L5 are risk factors for symptomatic L5-S1 foraminal stenosis. These dynamic radiological findings support the diagnosis of symptomatic foraminal stenosis.

Cited by 19 publications

References 22 publications

AAAPT Diagnostic Criteria for Acute Low Back Pain with and Without Lower Extremity Pain

AAAPT Diagnostic Criteria for Acute Low Back Pain with and Without Lower Extremity Pain

Do Curve Characteristics Influence Stenosis Location and Occurrence of Radicular Pain in Adult Degenerative Scoliosis?

Is multidetector computed tomography comparable to magnetic resonance imaging for assessment of lumbar foraminal stenosis?

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