Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR Imaging |
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Authors: | Mustafa Sirvanci Mona Bhatia Kursat Ali Ganiyusufoglu Cihan Duran Mehmet Tezer Cagatay Ozturk Mehmet Aydogan Azmi Hamzaoglu |
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Institution: | (1) Department of Radiology, İstanbul Bilim University, Buyukdere cad. No: 120, Esentepe-Zincirlikuyu, Istanbul, Turkey;(2) Department of Radiology, Florence Nightingale Hospital, Abide-i Hurriyet cad. No: 290 Caglayan, Sisli, Istanbul, Turkey;(3) İstanbul Spine Center, Florence Nightingale Hospital, Abide-i Hurriyet cad. No: 290 Caglayan, Sisli, Istanbul, Turkey |
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Abstract: | Because neither the degree of constriction of the spinal canal considered to be symptomatic for lumbar spinal stenosis nor
the relationship between the clinical appearance and the degree of a radiologically verified constriction is clear, a correlation
of patient’s disability level and radiographic constriction of the lumbar spinal canal is of interest. The aim of this study
was to establish a relationship between the degree of radiologically established anatomical stenosis and the severity of self-assessed
Oswestry Disability Index in patients undergoing surgery for degenerative lumbar spinal stenosis. Sixty-three consecutive
patients with degenerative lumbar spinal stenosis who were scheduled for elective surgery were enrolled in the study. All
patients underwent preoperative magnetic resonance imaging and completed a self-assessment Oswestry Disability Index questionnaire.
Quantitative image evaluation for lumbar spinal stenosis included the dural sac cross-sectional area, and qualitative evaluation
of the lateral recess and foraminal stenosis were also performed. Every patient subsequently answered the national translation
of the Oswestry Disability Index questionnaire and the percentage disability was calculated. Statistical analysis of the data
was performed to seek a relationship between radiological stenosis and percentage disability recorded by the Oswestry Disability
Index. Upon radiological assessment, 27 of the 63 patients evaluated had severe and 33 patients had moderate central dural
sac stenosis; 11 had grade 3 and 27 had grade 2 nerve root compromise in the lateral recess; 22 had grade 3 and 37 had grade
2 foraminal stenosis. On the basis of the percentage disability score, of the 63 patients, 10 patients demonstrated mild disability,
13 patients moderate disability, 25 patients severe disability, 12 patients were crippled and three patients were bedridden.
Radiologically, eight patients with severe central stenosis and nine patients with moderate lateral stenosis demonstrated
only minimal disability on percentage Oswestry Disability Index scores. Statistical evaluation of central and lateral radiological
stenosis versus Oswestry Disability Index percentage scores showed no significant correlation. In conclusion, lumbar spinal
stenosis remains a clinico-radiological syndrome, and both the clinical picture and the magnetic resonance imaging findings
are important when evaluating and discussing surgery with patients having this diagnosis. MR imaging has to be used to determine
the levels to be decompressed. |
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Keywords: | Spine abnormalities Spine MR Lumbar spinal stenosis Oswestry Disability Index |
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