Management Protocol of Patients with Lumbar Spinal Stenosis, using the Qualitative Grading as a Tool

Abstract

Objectives: Several parameters exist for assessment of lumbar spinal stenosis (LSS) but these parameters lack clinical correlation. To formulate a protocol for management of these group of patients using the qualitative grading as a tool. Materials and methods: A prospective study was undertaken using the qualitative grading on magnetic resonance imaging (MRI) to assess the clinical outcome of LSS at a single level. Irrespective of the grade every patient underwent a minimum 3 months period of conservative management after which depending on the oswestry disability index (ODI) and visual analog scale (VAS) for pain he was grouped into success or failure and the failed patients were advised for decompression surgery at the involved level. These patients were then further assessed after a period of 3 months after surgery. A decrease in ODI by 10 points and a 20 points decrease in VAS was considered as a success. Results: Out of the 90 patients, there were 61 failures in conservative group, out of these 57 were operated of which only nine did not match the success criteria, while the other four either refused surgery or were lost to follow-up. In grades A1 to 3, only two patients failed conservative trial while from A4 to D, there was a gradual decline in success of conservative trial. Conclusion: Qualitative grading is a useful tool in LSS and correlates with the clinical outcome and to decision making of these patients.