Lateral Lumbar Spinal Stenosis: Associations With the Oswestry Disability Index, Visual Analogue Scale, and Magnetic Resonance Imaging.

Abstract

Introduction Degenerative lumbar spinal stenosis is a communal problem in the sixth decade of life involving L4/L5 and L5/S1 levels. Lateral spinal stenosis is often underestimated because of no established relationship between the clinical symptoms and MRI findings. We conducted a study to establish an association between the degree of anatomical lateral stenosis, posterior disc height, and disc degeneration from MRI with the daily disability and pain severity for lateral lumbar spinal stenosis. Methods This was a cross-sectional study involving 121 patients with distinct clinical symptoms of lateral lumbar spinal stenosis evaluated from February 2018 to December 2019. The clinical data were evaluated using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS), while magnetic resonance imaging (MRI) was assessed qualitatively for the anatomical gradation of lateral spinal stenosis, the magnitude of posterior disc height, and the extent of disc degeneration. Statistical analysis for the correlation between posterior disc height and ODI and VAS scores was evaluated using Pearson's correlation test via SPSS version 23.0 (IBM Inc., Armonk, New York), and the association between the extent of lateral stenosis and disc degeneration on MRI with ODI and VAS scores was determined by the Fisher Exact Test via STATA version 14.0 (StataCorp LLC, College Station, Texas). The association was considered statistically significant with a P-value of less than 0.05. Results The analysis of 121 patients showed the mean age of the patients was 58.7 ± 7.1 years old. The number of female patients was higher compared tomale patients, 52.9% and 47.1%, respectively. 97.5% of the patients were married or cohabiting, and 76.0% had an abnormal body mass index. The mean score of ODI and VAS was 62.2 ± 10.7% and 79.3 ± 8.6 respectively. 49.6% of the patient presented with a crippling disability with ODI assessment, while 59.5% presented with high pain intensity with VAS assessment. MRI assessment of anatomical grading lateral stenosis of L4/L5 level revealed that 45.5% of the patients had grade 2 lateral recess stenosis, 63.6% had grade 2 foraminal stenosis, and 44.6% had extraforaminal stenosis. L5/S1 level analysis showed that 43.0% had grade 2 lateral recess stenosis, 62.0% had grade 2 foraminal stenosis, and 29.8% had extraforaminal stenosis. 64.5% of patients had grade 4 disc degeneration of L4/L5 with mean posterior disc height of 7.0mm ±1.7mm while 59.5% had grade 4 disc degeneration of L5/S1 with mean posterior disc height of 6.3mm ±1.8mm. However, no statistically significant association between clinical symptoms and MRI findings was found. Conclusions There was no significant association between the clinical symptoms of pain and disability and the MRI findings for the anatomical gradation of lateral spinal stenosis, the magnitude of posterior disc height, and the extent of disc degeneration. A comprehensive clinical evaluation remains essential for an accurate diagnosis, emphasizing the necessity of appropriately correlating MRI findings with their clinical significance.