scholarly journals Comparison of Plain X-ray and MRI Findings By Determining The Sensitivity and Specificity in the Diagnosis of Lumbar Spinal Stenosis

KYAMC Journal ◽  
2021 ◽  
Vol 12 (3) ◽  
pp. 161-165
Author(s):  
Nazif Sultana ◽  
Fatama Sharmin ◽  
AHM Tanvir Hasan Siddiquee ◽  
SM Mazharul Islam ◽  
Enayet Karim
Keyword(s):  
Positive Predictive Value ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Predictive Value ◽  
Spinal Canal ◽  
Spinal Canal Stenosis ◽  
X Ray ◽  
Canal Stenosis ◽  
Lumbar Spinal ◽  
Mri Evaluation

Background: Lumbar spinal stenosis is the most frequent indication for spine surgery. The X-ray and MRI are the choice of investigation. Justified use of radiography can be cost effective in the management of lumbar spinal stenosis. Objective: To evaluate and compare the sensitivity and specificity of the plain X-ray and MRI in the diagnosis of the lumbar spinal stenosis. Materials and Methods: A multicenter cross sectional analytical study was carried out from January 2014 to December 2015 on 70 patients of both sexes aged more than 25 years with chronic low back pain. Plain x-ray and MRI were done in all patients. The interval between plain x-ray and MRI was less than 3 months. A descriptive analysis was performed for all data. Results: The mean age (+ SD) was 45.1 (+ 5.4) years. Forty two (60%) were male and 28 (40%) were female. In plain x-ray of the lumbosacral spine, 30 (42.9%) had diskogenic spinal canal stenosis and 22 (31.4%) had both diskogenic and non diskogenic spinal canal stenosis. In the MRI, 35 (50.0%) cases had diskogenic spinal canal stenosis and 24 (34.3%) had both diskogenic and non diskogenic spinal canal stenosis. The validity of MRI evaluation for only diskogenic spinal canal stenosis was correlated, where the calculated values of plain x-ray were: sensitivity 80.0%, specificity 60.0%, accuracy 77.5%, positive predictive value 93.3% and negative predictive value 30.0%. The validity of MRI evaluation for both diskogenic and non diskogenic spinal canal stenosis was correlated, where the calculated values of plain x-ray were: sensitivity 83.3%, specificity 66.7%, accuracy 80.0%, positive predictive value 90.9% and negative predictive value 50.0%. Conclusion: Plain x-ray is a useful and reliable diagnostic modality for the evaluation, assessment and the subsequent appropriate management of lumbar spinal stenosis. KYAMC Journal. 2021;12(3): 161-165

X-RAY AND MAGNETIC RESONANCE IMAGING FEATURES IN PATIENTS WITH ACQUIRED LUMBAR SPINAL STENOSIS

2018 ◽  
Vol 8 (6) ◽  
pp. 151-156
Author(s):  
Trung Hoang Van ◽  
Cuong Le Van Ngoc
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Canal ◽  
Resonance Imaging ◽  
X Ray ◽  
Canal Stenosis ◽  
Lumbar Spinal Canal ◽  
Lumbar Spinal

Background: Lumbar spinal stenosis often associates with chronic pain described the abnormal narrowing of the lumbar spinal canal, resulting in compression of neural elements within the central spinal canal or the lateral recesses or the root canals or coordinate with each other. The purpose of this study was to describe and compare the plain X-ray and magnetic resonance imaging features of lumbar canal stenosis. Materials and methods: This was a cross-sectional study of 78 patients with an acquired lumbar spinal canal between October 2017 and May 2018. Results: The X-rays confirmed osteophytes in 92.3%, endplate sclerosis in 88.5% and disc space narrowing 62.8%. On MRI, 213 lumbar levels were lumbar spinal canal stenosis, 181 lumbar levels were evaluated for the grade of central spinal canal stenosis. Conclusions: X-ray examination has limitations in a diagnosis of lumbar spinal stenosis but also serves as a diagnostic aid. MRI is well diagnosed as spinal pathology as well as lumbar spinal stenosis. Key words: Lumbar spinal, Lumbar spinal stenosis, Magnetic resonance imaging (MRI), X-ray, Grading

Effect Comparison Of MIS-TLIF Under MED and Quadrant Modes in The Treatment of Lu mbar Spinal Stenosis

2021 ◽  
Vol 7 (5) ◽  
pp. 1598-1604
Author(s):  
Chen Qi ◽  
Xia Chen ◽  
Mao Guangfeng ◽  
Chen Chuyong ◽  
Jin Yongming ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Canal ◽  
Spinal Canal Stenosis ◽  
Surgical Trauma ◽  
Canal Stenosis ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Lumbar Spinal

Background Lumbar spinal stenosis is one of the common causes of low back and leg pain. Lumbar intervertebral disc degeneration leads to the decrease of intervertebral height, the limitation of vertebral activity, and the biomechanical changes of the lumbar spine, which in turn makes the lumbar anterior convex angle and sacral inclination angle smaller, and the pelvic inclination angle larger, affecting the stress distribution of the lumbar spine aggravating the intervertebral disc degeneration. If the spinal canal stenosis is not corrected for a long time, can cause the cauda equina nerve, nerve root compression, resulting in neurogenic intermittent claudication. If the spinal canal stenosis is not corrected for a long time, can cause the cauda equina nerve, nerve root compression, resulting in neurogenic intermittent claudication. Surgery can correct lumbar stenosis and reconstruct lumbar stability. But the traditional lumbar fusion trauma is huge, even can aggravate pain, spinal canal stenosis. Therefore, more and more patients are more inclined to MIS-TLIF treatment with less surgical trauma. For single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open surgery in restoring lumbar interbody height and improving lumbar-pelvis balance. Objective Discussion on the effect difference of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar spinal stenosis by Quadrant and MED methods. Methods A total of 96patients with lumbar spinal stenosis who were scheduled to undergo MIS-TLIF surgery in Our Hospital from January 2017 to October 2020 were selected and divided into group A and group B according to the surgical channel selection scheme, with 48 cases in each group. The patients in group A were treater with MED channel, and the patients in group B were treated with Quadrant channel. The degree of surgical trauma, VAS score before and postoperative, JOA score, lumbar-pelvic imaging parameters and surgical complications were compared between the two methods. Results The operation time of the A group was shorter than that of the group B(P < 0.05). The blood loss, exposure time under X line, drainage flow and down-ground time in A group were lower than those in B group, which had statistical significance (P<0.05) ; A and B groups of patients were compared, the difference was not statistically significant (P>0.05) ; Preoperative, Comparison of VAS scores between A and B groups, the difference was not statistically significant (P>0.05) . On the first day of postoperative, the VAS score of group A was lower than that of groupB, which had statistical significance (P < 0.05). Preoperative, Comparison of JOA scores between A and B groups, the difference was not statistically significant (P>0.05) ; Comparison of JOA scores between 1 month ,3 months and 6 months in Postoperative, the difference was not statistically significant (P>0.05). The JOA scores of the two groups at 1 month, 3 months and 6 months postoperative were significantly lower than those Preoperative (P < 0.05). Six months postoperative, the lumbar anterior convex angle, segmental anterior convex angle and intervertebral height of the two groups were significantly higher than those Preoperative (P<0.05), and the pelvic inclination angle of the two groups was lower than that Preoperative (P<0.05).Conclusion MIS-TLIF in the treatment of patients with lumbar spinal stenosis using MED channel or Quadrant channel operation has curative effect, and there is little difference in the recovery of lumbar-pelvis imaging parameters, but the former has the advantages of less surgical trauma and lower postoperative pain.

Internal Decompression for Multiple Levels of Lumbar Spinal Stenosis: A Technical Note

Neurosurgery ◽  
1982 ◽  
Vol 11 (4) ◽  
pp. 546-549 ◽  
Author(s):  
Paul M. Lin
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Canal ◽  
Posterior Lumbar Interbody Fusion ◽  
Pain Syndrome ◽  
Technical Note ◽  
Canal Stenosis ◽  
Spinous Processes ◽  
Multiple Levels ◽  
Lumbar Spinal

Abstract In cases of lumbar spinal stenosis, use of the wide decompressive procedure for neural compression without regard for the integrity of facets tends to lead to instability and the chronic pain syndrome. Experience with the posterior lumbar interbody fusion technique indicates that, in cases of multiple levels of spinal canal stenosis, the decompression can be made adequately by inferior and superior marginal laminotomy, mesial facetectomy with an osteotome, and foraminotomy with an angle bone punch and a supersonic curette. Internal thinning of the thickened lamina can be achieved by the shaving action of the supersonic curette done from within the spinal canal. This technique achieves the necessary internal decompression of the multiple levels of spinal stenosis without interruption of the integrity of the motion segment. The spinous processes and the supraspinous ligaments and the lateral half of the facet, with its firm fibrous capsules, are scrupulously preserved. The disc is not removed unless it is overtly extruded.

scholarly journals “Slalom”: Microsurgical Cross-Over Decompression for Multilevel Degenerative Lumbar Stenosis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
H. Michael Mayer ◽  
Franziska Heider
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Canal ◽  
Facet Joint ◽  
Leg Pain ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Canal Stenosis ◽  
Microsurgical Decompression ◽  
Lumbar Spinal Canal ◽  
Lumbar Spinal

Objective.Selective, bilateral multisegmental microsurgical decompression of lumbar spinal canal stenosis through separate, alternating cross-over approaches.Indications. Two-segmental and multisegmental degenerative central and lateral lumbar spinal stenosis.Contraindications. None.Surgical Technique.Minimally invasive, muscle, and facet joint-sparing bilateral decompression of the lumbar spinal canal through 2 or more alternating microsurgical cross-over approaches from one side.Results.From December 2010 until December 2015 we operated on 202 patients with 2 or multisegmental stenosis (115 f; 87 m; average age 69.3 yrs, range 51–91 yrs). All patients were suffering from symptoms typical of a degenerative lumbar spinal stenosis. All patients complained about back pain; however the leg symptoms were dominant in all cases. Per decompressed segment, the average OR time was 36 min and the blood loss 45.7 cc. Patients were mobilized 6 hrs postop and hospitalization averaged 5.9 days. A total of 116/202 patients did not need submuscular drainage. 27/202 patients suffered from a complication (13.4%). Dural tears occurred in 3.5%, an epidural hematoma in 5.5%, a deep wound infection in 1.98%, and a temporary radiculopathy postop in 1.5%. Postop follow-up ranged from 12 to 24 months. There was a significant improvement of EQ 5 D, Oswestry Disability Index (ODI), VAS for Back and Leg Pain, and preoperative standing times and walking distances.

Diagnosis of Lumbar Spinal Stenosis with Functional Myelography

2018 ◽  
Vol 79 (04) ◽  
pp. 316-322 ◽  
Author(s):  
Sandra Frantz ◽  
Roberto Dezena ◽  
Carlos Pereira ◽  
Marcos Tatagiba ◽  
Matthias Morgalla
Keyword(s):  
Positive Predictive Value ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Predictive Value ◽  
Correct Diagnosis ◽  
Surgical Strategy ◽  
Inclusion Criteria ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Lumbar Spinal

Background and Study Aims The diagnosis of a lumbar spinal stenosis demands advanced diagnostic radiologic techniques. In recent decades magnetic resonance imaging (MRI) has replaced myelography, now considered an old-fashioned technique. It was our hypothesis that functional myelography still plays an important role in selected cases. We investigated how our surgical strategy was influenced by the results of MRI, functional myelography, and postmyelography computed tomography (CT) in patients with a lumbar spinal stenosis. Methods The sagittal diameters of the lumbar spinal canal were measured from L1 to S1 on patients with lumbar spinal stenosis. MRI, functional myelography, and postmyelography CT were compared in each of the patients. Sensitivity and specificity were calculated in each method. We examined how the surgical strategy was influenced by the results of these different methods. Results Fifty consecutive patients (21 women and 29 men; mean age: 70 years, [range: 49–86 years]) fulfilled the inclusion criteria. Functional myelography revealed a sensitivity of 0.99, a specificity of 0.79, and a positive predictive value of 0.45. The MRI exhibited a sensitivity of 0.93, a specificity of 0.74, and a positive predictive value of 0.39. Postmyelography CT showed a sensitivity of 0.96, a specificity of 0.75, and a positive predictive value of 0.41. A functional myelography revealed more information than the MRI and resulted in a change in the surgical strategy in 11 of 50 patients (22%) in comparison with the sole results of MRI or a postmyelography CT. Conclusions In selected cases with multilevel lumbar spinal stenosis, functional myelography revealed the highest precision in reaching a correct diagnosis. It resulted in a change in the surgical approach in every fifth patient in comparison with the MRI and proved most helpful, especially in elderly patients.

The nerve root sedimentation sign in diagnosis of lumbar spinal stenosis

2018 ◽  
Vol 60 (5) ◽  
pp. 634-642
Author(s):  
Małgorzata Piechota ◽  
Robert Król ◽  
David A. Elias ◽  
Wojciech Wawrzynek ◽  
Andrzej Lekstan
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Nerve Root ◽  
Spinal Canal Stenosis ◽  
Lumbar Spinal Canal Stenosis ◽  
Nerve Roots ◽  
Severe Stenosis ◽  
Dural Sac ◽  
Canal Stenosis ◽  
Lumbar Spinal

Background The nerve root sedimentation sign is a magnetic resonance (MR) sign, shown to be present in central lumbar spinal stenosis. The lack of sedimentation of the nerve roots to the dorsal part of the dural sac is consistent with the positive nerve root sedimentation sign. Purpose To validate the reliability of the nerve root sedimentation sign in diagnosis of different grades of lumbar spinal canal stenosis. Material and Methods This study was a retrospective review of 101 consecutive MR imaging (MRI) studies obtained on patients with clinically suspected lumbar canal stenosis. Based on the minimum anteroposterior (AP) diameter of the dural sac the study sample was classified into two groups: a group with morphological lumbar spinal stenosis; and the group of patients free from stenosis (AP > 12 mm). Patients with stenosis were further subclassified based on its severity: severe stenosis (AP ≤ 10 mm); and moderate stenosis (AP > 10 mm to ≤ 12 mm). Results Positive sedimentation sign was identified in 81% of patients with severe lumbar spinal stenosis and 14% of patients with moderate stenosis. No patients without lumbar spinal stenosis had a positive nerve root sedimentation sign. Of patients with a positive nerve root sedimentation sign, 89% presented with neurological claudication. Conclusion The nerve root sedimentation is a useful tool for identification of patients with both severe clinical and morphological lumbar spinal stenosis; however, its performance in the diagnosis of patients with moderate morphological spinal stenosis is poor.

Retrospective Matched-Pair Cohort Study on Effect of Bisegmental Fenestration versus Hemilaminectomy for Bisegmental Spinal Canal Stenosis at L3–L4 and L4–L5

2017 ◽  
Vol 78 (05) ◽  
pp. 431-439 ◽  
Author(s):  
Friedrich Weber ◽  
Julia Schüppel
Keyword(s):  
Cohort Study ◽  
Spinal Stenosis ◽  
Spinal Canal ◽  
Spinal Canal Stenosis ◽  
Matched Pair ◽  
Lumbar Spinal Canal Stenosis ◽  
Canal Stenosis ◽  
The Individual ◽  
Lumbar Spinal ◽  
Postoperative Improvement

Background The main symptoms of degenerative lumbar spinal canal stenosis are progressive back pain, spinal claudication, and, occasionally, sensory and motor deficits. Impairments particularly occur during walking, standing, and sitting. Thus social and vocational activities are increasingly restricted, causing considerable suffering for patients. Surgical therapies are superior to conservative ones. This article studies the outcome of 2-level fenestration versus hemilaminectomy for bisegmental spinal stenosis decompression. Methods This retrospective matched-pair cohort study included a total of 144 patients who underwent surgery for bisegmental spinal stenosis at the levels L3-4 and L4-5 between 2008 and 2012. There were 72 matching pairs that corresponded in sex, year of birth, and width of the stenosed segments. The patients' impairments were reported before, immediately after, and 6 and 12 months after surgery using the Oswestry Disability Questionnaire (ODQ-D) and the EuroQol-5D (EQ-5D). The data were evaluated statistically. Results The comparison of both surgical procedures regarding walking ability (walking a distance with and without a walking aid) revealed a significant difference. Patients who underwent hemilaminectomy had better postoperative results. The individual criteria of the ODQ-D and EQ-5D revealed no significant differences between 2-level fenestration and hemilaminectomy; however, there is always significant postoperative improvement in comparison with preoperative status. Age, sex, body mass index, comorbidities, smoking, and alcohol consumption had no influence on the surgical results. The reoperation rate was between 13% and 15% for both surgical techniques, not being significantly different. Conclusion Fenestration and hemilaminectomy are equivalent therapies for bisegmental lumbar spinal canal stenosis. Regarding walking, the study revealed better results for hemilaminectomy than for fenestration in this cohort of patients. Pain intensity, personal care, lifting and carrying of objects, sitting, social life, and travel all improved significantly postoperatively as compared with preoperatively. In both groups, health status as the decisive predictor improved considerably after surgery. We could show that both surgical methods result in significant postoperative improvement of all the individual criteria of the ODQ-D and the EQ-5D.

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