Reply to the Letter to the Editor of Jin Yang et al. concerning “Correlations between sedimentation sign, dural sac cross-sectional area, and clinical symptoms of degenerative lumbar spinal stenosis” by Sangbong Ko (Eur Spine J [2018] 27: 1623–1628)

Abstract Background Degenerative lumbar spinal stenosis (DLSS) is a common degenerative condition in older adults. Muscle atrophy (MA) is a leading cause of muscle weakness and disability commonly reported in individuals with spinal stenosis. The purpose of this study was to investigate if the MA correlates with the grade of spinal stenosis in patients with DLSS. Methods A retrospective analysis on 48 male and 184 female DLSS patients aged around 54.04 years (54.04 ± 8.93) were involved and divided into 6 groups according to claudication-distance-based grading of spinal stenosis, which confirmed by two independent orthopedic surgeons using T2- weighted images. Using 1.5T MRI scanner, the severity of MA is assessed based on its negative correlation with the ratio of total fat-free multifidus muscle cross-sectional area (TFCSA) to total multifidus muscle cross-sectional area (TCSA). Adobe Photoshop CS6 was used for qualitative image analysis and calculate the TFCSA/TCSA ratio to assess the severity of MA, compare the grade of MA with the spinal stenosis segment, stenosis grade and symptom side. Results In DLSS group, The TFCSA/TCSA ratio are 74.33 ± 2.18 in L3/4 stenosis, 75.51 ± 2.79 in L4/5 stenosis, and 75.49 ± 2.69 in L5/S1 stenosis. there were significant decreases in the TFCSA/TCSA ratio of stenotic segments compared with non-stenotic segments of the spinal canal (P < 0.05) while no significant difference between the non-stenotic segments (P > 0.05). TFCSA/TCSA ratios is significant differences in the TFCSA/TCSA ratios of the 6 DLSS groups (F = 67.832; P < 0.05). From Group 1 to Group 6, the TFCSA/TCSA ratio of stenotic segments positively correlated with the absolute claudication distance (ACD). (P < 0.001, r = 0.852). Besides, the TFCSA/TCSA ratios are smaller in the symptomatic sides of the spine than the contralateral sides (t = 4.128, P = 0.001). Conclusions The stenotic segments of the spinal canal are more atrophied than the non-stenotic segment in DLSS patients. It is shows that a strong positive correlation between the severity of multifidus atrophy and the severity of spinal stenosis.

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Dural Sac Cross-Sectional Area Does Not Correlate with Efficacy of Percutaneous Adhesiolysis in Single Level Lumbar Spinal Stenosis

January 2018 - Pain Physician ◽

10.36076/ppj.2011/14/377 ◽

2011 ◽

Vol 4;14 (4;7) ◽

pp. 277-282

Author(s):

Dr. Chan Hong Park

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Cross Sectional Area ◽

Low Back ◽

Sectional Area ◽

Cross Sectional ◽

Epidural Steroid Injections ◽

Dural Sac ◽

Lumbar Spinal ◽

Epidural Steroid

Background: Spinal stenosis is a narrowing of the spinal canal, which causes mechanical compression of spinal nerve roots. The compression of these nerve roots can cause low back pain and/or leg pain, as well as neurogenic claudication. Lumbar epidural steroid injections have commonly been used in patients with lumbar spinal stenosis (LSS). In cases that are refractory to epidural steroid injections, percutaneous epidural adhesiolysis has been used. Objective: The aim of our study is to determine the relationship between the severity of spinal stenosis and the participants’ response to adhesiolysis, and to evaluate the mid-term effectiveness of adhesiolysis. Study Design: A prospective observational study. Methods: Sixty-six patients with degenerative LSS were enrolled in this prospective study. All participants underwent lumbar spine magnetic resonance imaging (MRI). The cross-sectional area of the dural sac was measured on the transverse angled sections through the central part of the disc on conventional MR images. All percutaneous adhesiolyses were performed in the operating room. One hour following the procedure, 6 mL of 8% sodium chloride solution was infused during 30 minutes in the recovery room while the patient underwent monitoring. Outcome measures were obtained using the 5-point patient satisfaction scale at 2 weeks and 6 months post-treatment. To evaluate outcome predictors, we divided the participants into 2 groups according to their response to treatment. Limitations: Secondary outcomes were not measured and the study did not include a long-term follow-up period. Results: Improvement (including reports of slightly improved, much improved, and no pain) was observed in 49 participants (74.2%) at 2 weeks and 45 participants (66.7%) at 6 months after the procedure. The dural sac cross-sectional area (DSCSA) did not differ between participants who reported improvement and those who did not. There was no statistically significant correlation between pain relief and DSCSA, age, or participant sex. Conclusion: Percutaneous adhesiolysis was shown to be effective for the treatment of LSS, with mid-term result, without affecting DSCSA. Key words: Low back pain, lumbar spinal stenosis, failed back surgery syndrome, dural sac, interventional techniques, epidural injection, percutaneous adhesiolysis.

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The Relationship Between the Cross-sectional Area of the Cauda Equina and the Preoperative Symptoms in Central Lumbar Spinal Stenosis

Spine ◽

10.1097/brs.0b013e318060a5f5 ◽

2007 ◽

Vol 32 (13) ◽

pp. 1423-1428 ◽

Cited By ~ 64

Author(s):

Osamu Ogikubo ◽

Lillemor Forsberg ◽

Tommy Hansson

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Cauda Equina ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

The Cross ◽

Lumbar Spinal ◽

The Relationship

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Usefulness of the Inferior Articular Process’s Cross-Sectional Area as a Morphological Parameter for Predicting Central Lumbar Spinal Stenosis

Journal of Clinical Medicine ◽

10.3390/jcm9010214 ◽

2020 ◽

Vol 9 (1) ◽

pp. 214

Author(s):

Sooho Lee ◽

Taeha Lim ◽

Young-Seob Lim ◽

Young Uk Kim

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Area Under The Curve ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Control Subjects ◽

Articular Process ◽

Analysis System ◽

Lumbar Spinal

Hypertrophy of facet joints is associated with a high risk of central lumbar spinal stenosis (CLSS). However, no research has reported the effect of inferior articular process hypertrophy in CLSS. We hypothesize that the inferior articular process’s cross-sectional area (IAPCSA) is larger in patients with CLSS compared to those without CLSS. Data on IAPCSA were obtained from 116 patients with CLSS. A total of 102 control subjects underwent lumbar spine magnetic resonance imaging (LS-MRI) as part of a routine medical examination. Axial T1-weighted images were obtained from the two groups. Using an imaging analysis system, we investigated the cross-sectional area of the inferior articular process. The average IAPCSA was 70.97 ± 13.02 mm2 in control subjects and 88.77 ± 18.52 mm2 in patients with CLSS. CLSS subjects had significantly greater levels of IAPCSA (p < 0.001) than controls. A receiver operating characteristic (ROC) curve was plotted to determine the validity of IAPCSA as a predictor of CLSS. The most suitable cut-off point of IAPCSA for predicting CLSS was 75.88 mm2, with a sensitivity of 71.6%, a specificity of 68.6%, and an area under the curve (AUC) of 0.78 (95% CI: 0.72–0.84). Greater IAPCSA levels were associated with a higher incidence of CLSS. These results demonstrate that IAPCSA is a useful morphological predictor in the evaluation of CLSS.

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Clinical and MRI findings in lumbar spinal stenosis: baseline data from the NORDSTEN study

European Spine Journal ◽

10.1007/s00586-021-07051-4 ◽

2021 ◽

Author(s):

Jørn Aaen ◽

Ivar Magne Austevoll ◽

Christian Hellum ◽

Kjersti Storheim ◽

Tor Åge Myklebust ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Patient Characteristics ◽

Cross Sectional Area ◽

Sectional Area ◽

Mri Findings ◽

Multifidus Muscle ◽

Cross Sectional ◽

Patient Reported ◽

Lumbar Spinal

Abstract Purpose The aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain. Methods The NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight. Results The percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm2) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (≥ 15°) 11.9%, degeneration of multifidus muscle (2–4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score. Conclusion In this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings. Trial registration www.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.

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Relative risk factors of nerve root sedimentation sign (Sedsign) in patients with severe central lumbar spinal stenosis (LSS)

10.21203/rs.3.rs-151289/v1 ◽

2021 ◽

Author(s):

Haiming YU ◽

Yunfeng HAN ◽

Rui ZHANG ◽

Chu SUN ◽

Mingda WANG ◽

...

Keyword(s):

Risk Factors ◽

Relative Risk ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Nerve Root ◽

Sectional Area ◽

Cross Sectional ◽

Dural Sac ◽

Significant Difference ◽

Lumbar Spinal

Abstract Here we evaluated the incidence of positive nerve root sedimentation sign (Sedsign) and its correlation with MRI parameters in patients with severe lumbar spinal stenosis (LSS) to explore its pathogenesis. Among 209 patients with severe LSS, there were 290 levels with intervertebral narrowing, among which 248 had a positive Sedsign (a prevalence of 85.52%). We then analyzed those levels with a positive Sedsign relative to those with a negative Sedsign (42 levels). There was no significant difference between the two groups for the minimum cross-sectional area (CSA) of the dural sac or the minimum posteroanterior diameter (PAD) of the spinal canal. In contrast, there was a significant difference between the groups for the grade of degenerative facet joint (DFJ) (p < 0.05), the maximum thickness of ligamentum flavum (TLF) (p < 0.01), and the maximum cross-sectional area difference (CSAD) of the dural sac (p < 0.01). In addition, receiver operating characteristic (ROC) curves were used to identify associated factors. The area under the ROC curve for PAD was 0.608 (95%CI: 0.55−0.665, p < 0.05), for DFJ was 0.634 (95%CI: 0.576−0.69, p < 0.05), for TLF was 0.74 (95%CI: 0.742−0.839, p < 0.01), and for CSAD was 0.911 (95%CI: 0.875−0.943, p < 0.01). In summary, a positive Sedsign has notable advantages in assisting with the diagnosis of severe LSS. Compression of the dural sac from the rear may be the main cause of a positive Sedsign, and the TLF and DFJ parameters were the main relative risk factors.

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