Top

European Spine Journal

Published in:

01-02-2017 | Original Article

A novel MRI classification system for congenital functional lumbar spinal stenosis predicts the risk for tandem cervical spinal stenosis

Authors: Carola F. van Eck, Nicholas T. Spina III, Joon Y. Lee

Published in: European Spine Journal | Issue 2/2017

Abstract

Purpose

The purpose of this study was to develop a simple and clinically useful morphological classification system for congenital lumbar spinal stenosis using sagittal MRI, allowing clinicians to recognize patterns of lumbar congenital stenosis quickly and be able to screen these patients for tandem cervical stenosis.

Methods

Forty-four subjects with an MRI of both the cervical and lumbar spine were included. On the lumbar spine MRI, the sagittal canal morphology was classified as one of three types: Type I normal, Type II partially narrow, Type III globally narrow. For the cervical spine, the Torg-Pavlov ratio on X-ray and the cervical spinal canal width on MRI were measured. Kruskal–Wallis analysis was done to determine if there was a relationship between the sagittal morphology of the lumbar spinal canal and the presence of cervical spinal stenosis.

Results

Subjects with a type III globally narrow lumbar spinal canal had a significantly lower cervical Torg-Pavlov ratio and smaller cervical spinal canal width than those with a type I normal lumbar spinal canal.

Conclusion

A type III lumbar spinal canal is a globally narrow canal characterized by a lack of spinal fluid around the conus. This was defined as “functional lumbar spinal stenosis” and is associated with an increased incidence of tandem cervical spinal stenosis.

Dagi TF, Tarkington MA, Leech JJ (1987) Tandem lumbar and cervical spinal stenosis. Natural history, prognostic indices, and results after surgical decompression. J Neurosurg 66(6):842–849. doi:10.3171/jns.1987.66.6.0842 CrossRefPubMed

Teng P, Papatheodorou C (1964) Combined cervical and lumbar spondylosis. Arch Neurol 10:298–307CrossRefPubMed

Lee MJ, Garcia R, Cassinelli EH, Furey C, Riew KD (2008) Tandem stenosis: a cadaveric study in osseous morphology. Spine J 8(6):1003–1006. doi:10.1016/j.spinee.2007.12.005 CrossRefPubMed

Bajwa NS, Toy JO, Young EY, Ahn NU (2012) Is congenital bony stenosis of the cervical spine associated with lumbar spine stenosis? An anatomical study of 1072 human cadaveric specimens. J Neurosurg Spine 17(1):24–29. doi:10.3171/2012.3.SPINE111080 CrossRefPubMed

Singh A, Tetreault L, Fehlings MG, Fischer DJ, Skelly AC (2012) Risk factors for development of cervical spondylotic myelopathy: results of a systematic review. Evid-Based Spine-Care J 3(3):35–42. doi:10.1055/s-0032-1327808 PubMedPubMedCentral

Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G (2010) 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(21):1919–1924. doi:10.1097/BRS.0b013e3181d359bd CrossRef

Singh K, Samartzis D, Vaccaro AR, Nassr A, Andersson GB, Yoon ST, Phillips FM, Goldberg EJ, An HS (2005) Congenital lumbar spinal stenosis: a prospective, control-matched, cohort radiographic analysis. Spine J 5(6):615–622. doi:10.1016/j.spinee.2005.05.385 CrossRefPubMed

Pavlov H, Torg JS, Robie B, Jahre C (1987) Cervical spinal stenosis: determination with vertebral body ratio method. Radiology 164(3):771–775. doi:10.1148/radiology.164.3.3615879 CrossRefPubMed

Bajwa NS, Toy JO, Young EY, Ahn NU (2012) Establishment of parameters for congenital stenosis of the cervical spine: an anatomic descriptive analysis of 1066 cadaveric specimens. Eur Spine J 21(12):2467–2474. doi:10.1007/s00586-012-2437-2 CrossRefPubMedPubMedCentral

10.

Iizuka H, Takahashi K, Tanaka S, Kawamura K, Okano Y, Oda H (2012) Predictive factors of cervical spondylotic myelopathy in patients with lumbar spinal stenosis. Arch Orthop Trauma Surg 132(5):607–611. doi:10.1007/s00402-012-1465-z CrossRefPubMed

11.

Lee SH, Kim KT, Suk KS, Lee JH, Shin JH, So DH, Kwack YH (2010) Asymptomatic cervical cord compression in lumbar spinal stenosis patients: a whole spine magnetic resonance imaging study. Spine (Phila Pa 1976) 35(23):2057–2063. doi:10.1097/BRS.0b013e3181f4588a CrossRef

12.

Bajwa NS, Toy JO, Ahn NU (2013) Is congenital bony stenosis of the cervical spine associated with congenital bony stenosis of the thoracic spine? An anatomic study of 1072 human cadaveric specimens. J Spinal Disord Tech 26(1):E1–E5. doi:10.1097/BSD.0b013e3182694320 CrossRefPubMed

13.

Bajwa NS, Toy JO, Ahn NU (2012) Is lumbar stenosis associated with thoracic stenosis? A study of 1072 human cadaveric specimens. Spine J 12(12):1142–1146. doi:10.1016/j.spinee.2012.10.029 CrossRefPubMed

14.

Bajwa NS, Toy JO, Ahn NU (2013) Application of a correlation between the lumbar Torg ratio and the area of the spinal canal to predict lumbar stenosis: a study of 420 postmortem subjects. J Orthop Traumatol: Off J Italian Soc Orthop Traumatol 14(3):207–212. doi:10.1007/s10195-013-0237-z CrossRef

15.

Hukuda S, Kojima Y (2002) Sex discrepancy in the canal/body ratio of the cervical spine implicating the prevalence of cervical myelopathy in men. Spine (Phila Pa 1976) 27(3):250–253CrossRef

Title: A novel MRI classification system for congenital functional lumbar spinal stenosis predicts the risk for tandem cervical spinal stenosis
Authors: Carola F. van Eck
Nicholas T. Spina III
Joon Y. Lee
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 2/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-016-4657-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A novel MRI classification system for congenital functional lumbar spinal stenosis predicts the risk for tandem cervical spinal stenosis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2017

German validation of the BIDQ-S questionnaire on body image disturbance in idiopathic scoliosis

Erratum to: Posterior implant removal in patients with thoracolumbar spine fractures: long-term results

Comparison of MRI-defined back muscles volume between patients with ankylosing spondylitis and control patients with chronic back pain: age and spinopelvic alignment matched study

Particulate and non-particulate steroids in spinal epidurals: a systematic review and meta-analysis

Degenerative lumbar spinal canal stenosis: intra- and inter-reader agreement for magnetic resonance imaging parameters

Determinants of patient satisfaction after surgery for central spinal stenosis without concomitant spondylolisthesis: a register study of 5100 patients