Clinical Importance of Radiological Parameters in Lumbar Spinal Stenosis

Czech version

Authors: E. Kalíková ¹; B. Adamová ¹; M. Keřkovský ²; J. Bednařík ¹
Authors‘ workplace: LF MU a FN Brno Neurologická klinika ¹; LF MU a FN Brno Radiologická klinika ²
Published in: Cesk Slov Neurol N 2017; 80/113(4): 400-407
Category: Review Article
doi: https://doi.org/10.14735/amcsnn2017400

Overview

The relationship between radiological findings (severity of radiological stenosis) and clinical manifestations in lumbar spinal stenosis (LSS) is unclear. The aim of the present study was to point out the discrepancy between radiological and clinical findings in LSS and high prevalence of asymptomatic lumbar stenosis, to evaluate the clinical importance of radiological parameters in diagnostics of LSS and to mention new radiological trends in LSS. According to published studies, LSS is a clinical and radiological syndrome with complex relationships between radiological findings and clinical manifestations. There is a high prevalence of radiological LSS including asymptomatic forms in the general population. Based on experts consensus, five core radiological qualitative parameters have been defined as a minimum standard in a radiological report describing LSS in routine clinical practice. Evaluation of these core radiological parameters is simple with high reproducibility and they describe nerve structures compression in lumbar spinal canal better than isolated quantitative radiological parameters. Magnetic resonance diffusion tensor imaging is a new trend in radiological diagnostics of LSS.

Key words:
lumbar spine – lumbar spinal stenosis – magnetic resonance imaging – diffusion tensor imaging

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J 2013;13(7):734– 43. doi: 10.1016/ j.spinee.2012.11.059.

2. Genevay S, Atlas SJ. Lumbar spinal stenosis. BestPract Res Clin Rheumatol 2010;24(2):253– 65. doi: 10.1016/ j.berh.2009.11.001.

3. Suri P, Rainville J, Kalichman L, et al. Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis? JAMA 2010;304(23):2628– 36. doi: 10.1001/ jama.2010.1833.

4. Schönström N, Willén J. Imaging lumbar spinal stenosis. Radiol Clin North Am 2001;39(1):31– 53.

5. Boden SD, Davis DO, Dina TS, et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J BoneJoint Surg Am 1990;72(3):403– 8.

6. Tong HC, Carson JT, Haig AJ, et al. Magnetic resonance imaging of the lumbar spine in asymptomatic older adults. J Back Musculoskelet Rehabil 2006;19(2– 3):67– 72.

7. 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 2013;21(6): 783– 8. doi: 10.1016/ j.joca.2013.02.656.

8. Kalichman L, Cole R, Kim DH, et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J 2009;9(7):545– 50. doi: 10.1016/ j.spinee.2009.03.005.

9. Haig AJ, Tong HC, Yamakawa KS, et al. Spinal stenosis, back pain, or no symptoms at all? A masked study comparing radiologic and electrodiagnostic diagnoses to the clinical impression. Arch Phys Med Rehabil 2006;87(7):897– 903.

10. Haig AJ, Geisser ME, Tong HC, et al. Electromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back pain, and no back symptoms. J Bone Joint Surg Am 2007;89(2):358– 66.

11. Geisser ME, Haig AJ, Tong HC, et al. Spinal canal size and clinical symptoms among persons diagnosed with lumbar spinal stenosis. Clin J Pain 2007;23(9):780– 5.

12. Zeifang F, Schiltenwolf M, Abel R, et al. Gait analysis does not correlate with clinical and MR imaging parameters in patients with symptomatic lumbar spinal stenosis. BMC Musculoskelet Disord 2008;9:89. doi: 10.1186/ 1471-2474-9-89.

13. Goni VG, Hampannavar A, Gopinathan NR, et al. Comparison of the oswestry disability index and magnetic resonance imaging findings in lumbar canal stenosis: an observational study. Asian Spine J 2014;8(1):44– 50. doi: 10.4184/ asj.2014.8.1.44.

14. Sirvanci M, Bhatia M, Ganiyusufoglu KA, et al. Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging. Eur Spine J 2008;17(5):679– 85. doi: 10.1007/ s00586-008-0646-5.

15. Lohman CM, Tallroth K, Kettunen JA, et al. Comparison of radiologic signs and clinical symptoms of spinal stenosis. Spine 2006;31(16):1834– 40.

16. Adamová B, Andrašinová T, Bušková J, et al. Korelují radiologické a klinické nálezy u pacientů s lumbální spinální stenózou? Cesk Slov Neurol N 2016;79/ 112(Suppl 2):2S37.

17. 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 2014;15:348. doi: 10.1186/ 1471-2474-15-348.

18. Kuittinen P, Sipola P, Aalto TJ, et al. Correlation of lateral stenosis in MRI with symptoms, walking capacity and EMG findings in patients with surgically confirmed lateral lumbar spinal canal stenosis. BMC Musculoskelet Disord 2014;15:247. doi: 10.1186/ 1471-2474-15-247.

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 2010;35(21):1919– 24. doi: 10.1097/ BRS.0b013e3181d359bd.

20. Burgstaller JM, Schüffler PJ, Buhmann JM, et al. Is There an Association Between Pain and Magnetic Resonance Imaging Parameters in Patients With Lumbar Spinal Stenosis? Spine 2016;41(17):E1053– 62. doi: 10.1097/ BRS.0000000000001544.

21. Alsaleh K, Ho D, Rosas-Arellano MP, et al. Radiographic assessment of degenerative lumbar spinal stenosis: is MRI superior to CT? Eur Spine J 2017;26(2):362– 7. doi: 10.1007/ s00586-016-4724-9.

22. 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 2007;32(13):1423– 8.

23. Hong JH, Lee MY, Jung SW, et al. Does spinal stenosis correlate with MRI findings and pain, psychologic factor and quality of life? Korean J Anesthesiol 2015;68(5):481– 7. doi: 10.4097/ kjae.2015.68.5.481.

24. 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 2015;24(10):2236– 43. doi: 10.1007/ s00586-015-4197-2.

25. 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 2016;41(2):E78– 83. doi: 10.1097/ BRS.0000000000001166.

26. Kim HJ, Suh BG, Lee DB, et al. The influence of pain sensitivity on the symptom severity in patients with lumbar spinal stenosis. Pain Physician 2013;16(2):135– 44.

27. Park HJ, Kim SS, Lee YJ, et al. Clinical correlation of a new practical MRI method for assessing central lumbar spinal stenosis. Br J Radiol 2013;86(1025):20120180. doi: 10.1259/ bjr.20120180.

28. Lee GY, Lee JW, Choi HS, et al. A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skeletal Radiol 2011;40(8):1033– 9. doi: 10.1007/ s00256-011-1102-x.

29. Adamová B, Mechl M, Andrašinová T, et al. Radiologické hodnocení lumbální spinální stenózy a jeho klinická korelace. Cesk Slov Neurol N 2015;78(2):139– 47.

30. Schizas C, Kulik G. Decision-making in lumbar spinal stenosis: a survey on the influence of the morphology of the dural sac. J Bone Joint Surg Br 2012;94(1):98– 101. doi: 10.1302/ 0301-620X.94B1.27420.

31. Porter RW. Spinal stenosis and neurogenic claudication. Spine 1996;21(17):2046– 52.

32. Andreisek G, Deyo RA, Jarvik JG, et al. Consensus conference on core radiological parameters to describe lumbar stenosis – an initiative for structured reporting. Eur Radiol 2014;24(12):3224– 32. doi: 10.1007/ s00330-014-3346-z.

33. Mamisch N, Brumann M, Hodler J, et al. Radiologic criteria for the diagnosis of spinal stenosis: results of a Delphi survey. Radiology 2012;264(1):174– 9. doi: 10.1148/ radiol.12111930.

34. Maus TP. Imaging of spinal stenosis: neurogenic intermittent claudication and cervical spondylotic myelopathy. Radiol Clin North Am 2012;50(4):651– 79. doi: 10.1016/ j.rcl.2012.04.007.

35. Andreisek G, Imhof M, Wertli M,et al. A systematic review of semiquantitative and qualitative radiologic criteria for the diagnosis of lumbar spinal stenosis. AJR Am J Roentgenol 2013;201(5):W735– 46. doi: 10.2214/ AJR.12.10163.

36. Lurie JD, Tosteson AN, Tosteson TD, et al. Reliability of readings of magnetic resonance imaging features of lumbar spinal stenosis. Spine 2008;33(14):1605– 10. doi: 10.1097/ BRS.0b013e3181791af3.

37. 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 2003;24(3):348– 60.

38. Pfirrmann CW, Dora C, Schmid MR, et al. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology 2004;230(2):583– 8.

39. Winklhofer S, Held U, Burgstaller JM, et al. Degenerative lumbar spinal canal stenosis: intra- and inter-reader agreement for magnetic resonance imaging parameters. Eur Spine J 2017;26(2):353– 61.

40. Kolář P, Štulík J, Kynčl M. Dynamické vyšetření bederní páteře pomocí magnetické rezonance – kazuistika. Cesk Slov Neurol N 2010;73/ 106(4):438– 42.

41. Pierpaoli C, Basser PJ. Toward a quantitative assessment of diffusion anisotropy. Magn Reson Med 1996;36(6):893– 906.

42. Keřkovský M, Šprláková-Puková A, Kašpárek T, et al. Diffusion tensor imaging – současné možnosti MR zobrazení bílé hmoty mozku. Cesk Slov Neurol N 2010;73/ 106(2):136– 42.

43. Keřkovský M, Šprláková-Puková A, Bednařík J, et al. Význam MR zobrazení difuze míchy v diferenciální diagnostice míšních lézí. Cesk Slov Neurol N 2013;76// 109(4):477– 81.

44. Oikawa Y, Eguchi Y, Inoue G, et al. Diffusion tensor imaging of lumbar spinal nerve in subjects with degenerative lumbar disorders. Magn Reson Imaging 2015;33(8):956– 61. doi: 10.1016/ j.mri.2015.05.002.

45. Eguchi Y, Ohtori S, Orita S, et al. Quantitative evaluation and visualization of lumbar foraminal nerve root entrapment by using diffusion tensor imaging: preliminary results. AJNR Am J Neuroradiol 2011;32(10):1824– 9. doi: 10.3174/ ajnr.A2681.

46. Chuanting L, Qingzheng W, Wenfeng X, et al. 3.0T MRI tractography of lumbar nerve roots in disc herniation. Acta Radiol 2014;55(8):969– 75. doi: 10.1177/ 0284185113508179.

47. Balbi V, Budzik JF, Duhamel A, et al. Tractography of lumbar nerve roots: initial results. Eur Radiol 2011;21(6):1153– 9. doi: 10.1007/ s00330-010-2049-3.

48. Kanamoto H, Eguchi Y, Suzuki M, et al. The diagnosis of double-crush lesion in the L5 lumbar nerve using diffusion tensor imaging. Spine J 2016;16(3):315– 21. doi: 10.1016/ j.spinee.2015.11.003.

49. Shi Y, Zong M, Xu X, et al. Diffusion tensor imaging with quantitative evaluation and fiber tractography of lumbar nerve roots in sciatica. Eur J Radiol 2015;84(4):690– 5. doi: 10.1016/ j.ejrad.2015.01.006.

50. Miyagi R, Sakai T, Yamabe E, et al. Consecutive assessment of FA and ADC values of normal lumbar nerve roots from the junction of the dura mater. BMC Musculoskelet Disord 2015;16:156. doi: 10.1186/ s12891-015-0576-4.

51. Eguchi Y, Ohtori S, Suzuki M, et al. Discrimination between Lumbar Intraspinal Stenosis and Foraminal Stenosis using Diffusion Tensor Imaging Parameters: Preliminary Results. Asian Spine J 2016;10(2):327– 34. doi: 10.4184/ asj.2016.10.2.327.

52. Chen HB, Wan Q, Xu QF, et al. Reducing surgical levels by paraspinal mapping and diffusion tensor imaging techniques in lumbar spinal stenosis. J Orthop Surg Res 2016;11(1):47. doi: 10.1186/ s13018-016-0382-1.

53. Facon D, Ozanne A, Fillard P, et al. MR diffusion tensor imaging and fiber tracking in spinal cord compression. AJNR Am J Neuroradiol 2005;26(6):1587– 94.

54. Cauley KA, Filippi CG. Diffusion-tensor imaging of small nerve bundles: cranial nerves, peripheral nerves, distal spinal cord, and lumbar nerve roots – clinical applications. AJR Am J Roentgenol 2013;201(2):W326– 35. doi: 10.2214/ AJR.12.9230.