Abstract/References

The association between clinical symptoms of lumbar spinal stenosis and MRI axial imaging findings

Yuki Fushimi, Koji Otani, Ryoji Tominaga, Masataka Nakamura, Miho Sekiguchi, Shin-ichi Konno

Author information
  • Yuki Fushimi

    Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine

  • Koji Otani

    Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine

  • Ryoji Tominaga

    Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine

  • Masataka Nakamura

    Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine

  • Miho Sekiguchi

    Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine

  • Shin-ichi Konno

    Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine

Abstract

Purpose: In diagnosing lumbar spinal stenosis (LSS), Magnetic Resonance Imaging (MRI) is appropriate to confirm the presence of anatomical stenosis of the spinal canal or compression of the nerve roots. However, it is known that morphological LSS is often present in asymptomatic subjects. There is still controversy about the relationship between anatomical LSS and symptomatic LSS. The aim of this study was to assess the association between qualitative imaging findings on MRI of the lumbar spine and symptomatic LSS.


Patients and methods: This was a cross-sectional study of 239 volunteers from an epidemiological survey that included 1,862 participants in total. MRI of the lumbar spine was evaluated in four categories: morphological grading of central stenosis and lateral recess stenosis, presence of the sedimentation sign, and severity of facet joint effusion. The relationship between these morphological evaluations and typical LSS symptoms as assessed by the self-administered, self-reported history questionnaire for lumbar spinal stenosis (LSS-SSHQ) was investigated by multiple logistic regression analysis.


Results: The odds ratio of the most severe central stenosis to no stenosis was 15.5 (95%CI: 1.4-164.9). Only the most severe central stenosis was associated with typical LSS symptoms, but not all cases with typical LSS symptoms were due to severe central stenosis.


Conclusion: Extreme severe central stenosis was strongly related to typical LSS symptoms. However, although subjects with severe central stenosis showed symptoms suggestive of LSS, these subjects did not always show typical LSS symptoms.

The cintent of reseach paper

References

1. Siebert E, Prüss H, Klingebiel R, et al. Lumbar spinal stenosis:syndrome, diagnostics and treatment. Nat Rev Neurol, 5:392-403, 2009.


2. Bartynski WS, Lin L. Lumbar root compression in the lateral recess:MR imaging, conventional myelography, and CT myelography comparison with surgical confirmation. AJNR Am J Neuroradiol, 24:348-360, 2003.


3. Kitamura M, Eguchi Y, Inoue G, et al. A case of symptomatic extra-foraminal lumbosacral stenosis (“far-out syndrome”) diagnosed by diffusion tensor imaging. Spine (Phila Pa 1976), 37:E854-E857, 2012.


4. North American Spine Society Clinical Guidelines. III. Definition and Natural History of Degenerative Lumbar Spinal Stenosis [homepage on the Internet]. North American Spine Society; 2011. Available from:https://www.spine.org/Portals/0/Assets/Downloads/ResearchClinicalCare/Guidelines/LumbarStenosis.pdf Accessed May 1, 2020.


5. Boden SD, Davis DO, Dina TS, et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am, 72:403-408, 1990.


6. Otani K, Kikuchi SI, Yabuki S, et al. Prospective one-year follow-up of lumbar spinal stenosis in a regional community. J Pain Res, 11:455-464, 2018.


7. Ogikubo O, Forsberg L, Hansson T. The relationship between the cross-sectional area of the cauda equina and the preoperative symptoms in central lumbar spinal stenosis. Spine (Phila Pa 1976), 32:1423-1428;discussion 1429, 2007.


8. Kuittinen P, Sipola P, Saari T, et al. Visually assessed severity of lumbar spinal canal stenosis is paradoxically associated with leg pain and objective walking ability. BMC Musculoskelet Disord, 15:348, 2014.


9. Kim YU, Kong YG, Lee J, et al. Clinical symptoms of lumbar spinal stenosis associated with morphological parameters on magnetic resonance images. Eur Spine J, 24:2236-2243, 2015.


10. Andrasinova T, Adamova B, Buskova J, et al. Is there a Correlation Between Degree of Radiologic Lumbar Spinal Stenosis and its Clinical Manifestation? Clin Spine Surg, 31:E403-E408, 2018.


11. Splettstößer A, Khan MF, Zimmermann B, et al. Correlation of lumbar lateral recess stenosis in magnetic resonance imaging and clinical symptoms. World J Radiol, 9:223-229, 2017.


12. Kushchayev SV, Glushko T, Jarraya M, et al. ABCs of the degenerative spine. Insights Imaging, 9:253-274, 2018.


13. Barz T, Melloh M, Staub LP, et al. Nerve root sedimentation sign:evaluation of a new radiological sign in lumbar spinal stenosis. Spine (Phila Pa 1976), 35:892-897, 2010.


14. Kim YK, Lee JW, Kim HJ, et al. Diagnostic advancement of axial loaded lumbar spine MRI in patients with clinically suspected central spinal canal stenosis. Spine (Phila Pa 1976), 38:E1342-E1347, 2013.


15. Kanno H, Ozawa H, Koizumi Y, et al. Increased Facet Fluid Predicts Dynamic Changes in the Dural Sac Size on Axial-Loaded MRI in Patients with Lumbar Spinal Canal Stenosis. AJNR Am J Neuroradiol, 37:730-735, 2016.


16. Igarashi A, Kikuchi S, Konno S. Correlation between inflammatory cytokines released from the lumbar facet joint tissue and symptoms in degenerative lumbar spinal disorders. J Orthop Sci, 12:154-160, 2007.


17. Vardeh D, Mannion RJ, Woolf CJ. Toward a Mechanism-Based Approach to Pain Diagnosis. J Pain, 17:T50-T69, 2016.


18. Otani K, Kikuchi S, Yabuki S, et al. Lumbar spinal stenosis has a negative impact on quality of life compared with other comorbidities:an epidemiological cross-sectional study of 1862 community-dwelling individuals. ScientificWorldJournal, 2013:590652, 2013.


19. Schizas C, Theumann N, Burn A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976), 35:1919-1924, 2010.


20. Chaput C, Padon D, Rush J, et al. The significance of increased fluid signal on magnetic resonance imaging in lumbar facets in relationship to degenerative spondylolisthesis. Spine (Phila Pa 1976), 32:1883-1887, 2007.


21. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics, 33:159-174, 1977.


22. Konno S, Kikuchi S, Tanaka Y, et al. A diagnostic support tool for lumbar spinal stenosis:a self-administered, self-reported history questionnaire. BMC Musculoskelet Disord, 8:102, 2007.


23. Vatcheva KP, Lee M, McCormick JB, et al. Multicollinearity in Regression Analyses Conducted in Epidemiologic Studies. Epidemiology (Sunnyvale), 6:227, 2016.


24. Kapural L, Mekhail N, Bena J, et al. Value of the magnetic resonance imaging in patients with painful lumbar spinal stenosis (LSS) undergoing lumbar epidural steroid injections. Clin J Pain, 23:571-575, 2007.


25. Sigmundsson FG, Kang XP, Jönsson B, et al. Correlation between disability and MRI findings in lumbar spinal stenosis:a prospective study of 109 patients operated on by decompression. Acta Orthop, 82:204-210, 2011.


26. Weber C, Giannadakis C, Rao V, et al. Is There an Association Between Radiological Severity of Lumbar Spinal Stenosis and Disability, Pain, or Surgical Outcome?:A Multicenter Observational Study. Spine (Phila Pa 1976), 41:E78-E83, 2016.


27. Ishimoto Y, Yoshimura N, Muraki S, et al. Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study. Osteoarthritis Cartilage, 21:783-738, 2013.


28. Majidi H, Shafizad M, Niksolat F, et al. Relationship Between Magnetic Resonance Imaging Findings and Clinical Symptoms in Patients with Suspected Lumbar Spinal Canal Stenosis:a Case-control Study. Acta Inform Med, 27:229-233, 2019.


29. Laudato PA, Kulik G, Schizas C. Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis. Eur Spine J, 24:2264-2268, 2015.


30. Zhang L, Chen R, Xie P, et al. Diagnostic value of the nerve root sedimentation sign, a radiological sign using magnetic resonance imaging, for detecting lumbar spinal stenosis:a meta-analysis. Skeletal Radiol, 44:519-527, 2015.

Figures (10)