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HSS Journal ®

Published in:

01-09-2006

A Novel Method for the Quantitative Evaluation of Lumbar Spinal Stenosis

Authors: Fengyu Zheng, MD, James C. Farmer, MD, Harvinder S. Sandhu, MD, Patrick F. O'Leary, MD

Published in: HSS Journal ® | Issue 2/2006

Abstract

Study design

A retrospective study of computed tomography (CT) myelographic images in patients with degenerative lumbar spinal stenosis (LSS).

Objectives

To introduce a new technique for the quantitative evaluation of LSS.

Background

Advances in hardware and software technology now permit inexpensive digitalization of radiological images, and enable methodologies for quantifying space available for neural elements in spinal canal. However, a valid method with quantitative evaluation of spinal stenosis in living patients has not been developed yet.

Methods and materials

Preoperative CT myelographic scans of 50 patients with degenerative LSS were collected for retrospective investigation. The patients subsequently underwent lumbar decompressive surgery. They included scans from thoracic vertebra 12 (T12) to sacrum (S1), in which each segment was scanned through both the vertebral body and disk. All CT scan films were digitized using a high-resolution digital camera. ImageTool™ software was used to measure three parameters: cross-sectional area of dural sac at disk level (A), cross-sectional area of spinal canal at midpedicular level (B), and cross-sectional area of vertebral body (C). The dural sac canal ratio (DSCR) was calculated as A/B×100%. Low DSCR implied severe dural sac compression with a high degree of stenosis. The spinal canal vertebral ratio (CVR) was also calculated as B/C×100%. Low CVR implied a low baseline of canal capacity for neural elements. They were calculated from T12 to S1.

Results

The study consisted of 26 male and 24 female patients, with an average age of 68.4 (35–97) years. A total of 295 segments were evaluated, of which 118 (40%) were surgically decompressed. There were wide ranges of canal cross-sectional areas (140–475 mm²) and dural sac cross-sectional area (54–435 mm²). Male patients had a slightly larger canal cross-sectional area than female patients at each level. The mean CVR was found decreased from T12 (26.1%) to L4 (18.3%). This was higher in female than in male patients, especially from T12 to L2 (P < 0.01). There were significant correlations between spinal canal and dural sac cross-sectional area (r = 0.55, P < 0.001), and also between CVR and DSCR (r = 0.31, P < 0.001). Of the levels decompressed, 82% was performed from the level L2 to L5, in which there was no significant difference in canal cross-sectional area and CVR between decompression and nondecompression (P > 0.05). There was a good correspondence between decreasing mean DSCR and increasing percentile of levels decompressed.

Conclusion

DSCR represents a useful method for the quantitative diagnosis of lumbar spinal canal stenosis. ImageTool™ software is a useful tool in measuring spinal morphometry.

Airaksinen O, Herno A, Turunen V, Saari T, Suomlainen O (1997) Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis. Spine 22:2278–2282PubMedCrossRef

Amundsen T, Weber H, Lilleas F, Nordal HJ, Abdelnoor M, Magnaes AB (1995) Lumbar spinal stenosis: Clinical and radiologic features. Spine 20:1178–1186PubMedCrossRef

Bolender NF, Schönström NS, Spengler DM (1985) Role of computed tomography and myelography in the diagnosis of central spinal stenosis. J Bone Jt Surg [Am] 67:240–246

Ciol MA, Deyo RA, Howell E, Kreif SK (1996) An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc 44:285–290PubMed

Drew R, Bhandari M, Kulkarni AV, Louw D, Reddy K, Dunlop B (2000) Reliability in grading the severity of lumbar spinal stenosis. J Spinal Disord 13(3):253–258PubMedCrossRef

Eisenstein S (1983) Lumbar vertebral canal morphometry for computerized tomography in spinal stenosis. Spine 8(2):187–191PubMedCrossRef

Eisenstein S (1977) The morphometry and pathological anatomy of the lumbar spine in South African negroes and caucasoids with specific reference to spinal stenosis. J Bone Jt Surg Br 59(2):173–180

Eisenstein S (1980) The trefoil configuration of the lumbar vertebral canal. A study of South African skeletal material. J Bone Jt Surg Br 62-B(1):73–77

Fang D, Cheung KM, Ruan D, Chan FL (1994) Computed tomographic osteometry of the Asian lumbar spine. J Spinal Disord 7(4):307–316PubMedCrossRef

10.

Herno A, Airaksinen O, Saari T, et al. (1999) Computed Tomography findings 4 years after surgical management of lumbar spinal stenosis. Spine 24:2234–2239PubMedCrossRef

11.

Herno A, Airaksinen O, Saari T (1994) Computed tomography after laminectomy for lumbar spinal stenosis: patients' pain pattern, walking capacity, and subjective disability had no correlation with computed tomography findings. Spine 19:1975–1978PubMedCrossRef

12.

Hitselberger WE, Witten RM (1968) Abnormal myelograms in asymptomatic patients. J Neurosurg 28:204–206PubMedCrossRef

13.

Hu RW, Jaglal S, Axcell T, Anderson G (1997) A population-based study of reoperations after back surgery. Spine 22:2263–2271CrossRef

14.

Johnsson KE, Rosen I, Uden A (1992) The natural course of lumbar spinal stenosis. Clin Orthop Rel Res 279:82–86

15.

Jonsson B, Annertz M, Sjoberg C, Stromqvist B (1997) A prospective and consecutive study of surgically treated lumbar spinal stenosis: Part II. Five-year follow-up by and independent observer. Spine 22:2938–2944PubMedCrossRef

16.

Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Liang MH (1996) Seven- to ten-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine 21:92–98PubMedCrossRef

17.

Katz JN, Lipson SJ, Lew RA, et al. (1997) Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis: patient selection, costs, and surgical outcomes. Spine 22:1123–1131PubMedCrossRef

18.

Katz JN, Stucki G, Lipson SJ, et al. (1999) Predictors of surgical outcome in degenerative lumbar spinal stenosis. Spine 24:2229PubMedCrossRef

19.

Kent DL, Haynor DR, Larson EB, Deyo RA (1992) Diagnosis of lumbar spinal stenosis in adults: a metaanalysis of the accuracy of CT, MR, and myelography. AJR Am J Roentgenol 158(5):1135–1144PubMed

20.

Kornberg M, Rechtine GR (1985) Quantitative assessment of the fifth lumbar spinal canal by computed tomography in symptomatic L4–L5 disc disease. Spine 10(4):328–330PubMedCrossRef

21.

Mariconda M, Zanforlino G, Celestino GA, Brancaleone S, Fava R, Milano C (2000) Factors influencing the outcome of degenerative lumbar spinal stenosis. J Spinal Disord 13(2):131–137PubMedCrossRef

22.

Oland G, Hoff TG (1996) Intraspinal cross-sectional area measured on myelography-computed tomography. Spine 21:1985–1989PubMedCrossRef

23.

Papp T, Porter RW, Craig CE, et al. (1997) Significant antenatal factors in the development of lumbar spinal stenosis. Spine 22:1805–1810PubMedCrossRef

24.

Postacchini F, Ripani M, Carpano S (1983) Morphometry of the lumbar vertebrae. An anatomic study in two caucasoid ethnic groups. Clin Orthop 172:296–303PubMed

25.

Schonstrom N, Willen J (2001) Imaging of low back pain II. Imaging lumbar spinal stenosis. Radiol Clin North Am 39(1):31–53PubMedCrossRef

26.

Schönström NSR, Bolender NF, Spengler DM, Hansson T (1984) Pressure changes within the cauda equina following constriction of the dural sac. An in vitro experimental study. Spine 9:49–52CrossRef

27.

Schönström NSR, Bolender NF, Spengler DM (1985) The pathomorphology of spinal stenosis as seen on CT scans of the lumbar spine. Spine 10:806–811PubMedCrossRef

28.

Silvers HR, Lewis PJ, Asch HL (1993) Decompressive lumbar laminectomy for spinal stenosis. J Neurosurg 78:695–701PubMedCrossRef

29.

Turner JA, Ersek M, Herron L, Deyo R (1992) Surgery for lumbar spinal stenosis: attempted meta-analysis of the literature. Spine 17:1–8PubMedCrossRef

30.

Ullrich CG, Binet EF, Sanecki MG, Kieffer SA (1980) Quantitative assessment of the lumbar spinal canal by computed tomography. Radiology 134(1):137–143, JanPubMed

31.

Zheng F, Sandhu HS, Cammisa PF, Girardi PF, Khan SN (2001) Predictors of functional outcome in elderly patients undergoing posterior lumbar spine surgery. J Spinal Disord 14:518–521PubMedCrossRef

Title: A Novel Method for the Quantitative Evaluation of Lumbar Spinal Stenosis
Authors: Fengyu Zheng, MD
James C. Farmer, MD
Harvinder S. Sandhu, MD
Patrick F. O'Leary, MD
Publication date: 01-09-2006
Publisher: Springer-Verlag
Published in: HSS Journal ® / Issue 2/2006
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI: https://doi.org/10.1007/s11420-006-9006-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A Novel Method for the Quantitative Evaluation of Lumbar Spinal Stenosis

Abstract

Study design

Objectives

Background

Methods and materials

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Study design

Objectives

Background

Methods and materials

Results

Conclusion

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