Abstract
PurposeTo study the predictive value of preoperative magnetic resonance imaging (MRI) findings for the two-year postoperative clinical outcome in lumbar spinal stenosis (LSS).Methods84 patients (mean age 63±11 years, male 43%) with symptoms severe enough to indicate LSS surgery were included in this prospective observational single-center study. Preoperative MRI of the lumbar spine was performed with a 1.5-T unit. The imaging protocol conformed to the requirements of the American College of Radiology for the performance of MRI of the adult spine. Visual and quantitative assessment of MRI was performed by one experienced neuroradiologist. At the two-year postoperative follow-up, functional ability was assessed with the Oswestry Disability Index (ODI 0–100%) and treadmill test (0–1000 m), pain symptoms with the overall Visual Analogue Scale (VAS 0–100 mm), and specific low back pain (LBP) and specific leg pain (LP) separately with a numeric rating scale from 0–10 (NRS-11). Satisfaction with the surgical outcome was also assessed.ResultsPreoperative severe central stenosis predicted postoperatively lower LP, LBP, and VAS when compared in patients with moderate central stenosis (p<0.05). Moreover, severe stenosis predicted higher postoperative satisfaction (p = 0.029). Preoperative scoliosis predicted an impaired outcome in the ODI (p = 0.031) and lowered the walking distance in the treadmill test (p = 0.001). The preoperative finding of only one stenotic level in visual assessment predicted less postoperative LBP when compared with patients having 2 or more stenotic levels (p = 0.026). No significant differences were detected between quantitative measurements and the patient outcome.ConclusionsRoutine preoperative lumbar spine MRI can predict the patient outcome in a two-year follow up in patients with LSS surgery. Severe central stenosis and one-level central stenosis are predictors of good outcome. Preoperative finding of scoliosis may indicate worse functional ability.
Highlights
Lumbar spinal stenosis (LSS) is defined as ‘‘buttock or lower extremity pain, which may occur with or without low back pain (LBP), associated with diminished space available for the neural and vascular elements in the lumbar spine’’ [1,2]
Incidence of lumbar spinal stenosis is increasing due to the aging population, which increase the frequency of more complex lumbar spine procedures, which in turn is associated with the more demand for the healthcare [3]
Our main finding was that the visually evaluated severity of lumbar spinal stenosis correlated with the postoperative clinical outcome
Summary
Lumbar spinal stenosis (LSS) is defined as ‘‘buttock or lower extremity pain, which may occur with or without low back pain (LBP), associated with diminished space available for the neural and vascular elements in the lumbar spine’’ [1,2]. LSS is the most common indication for lumbar spinal surgery in people aged over 65 years. Incidence of lumbar spinal stenosis is increasing due to the aging population, which increase the frequency of more complex lumbar spine procedures, which in turn is associated with the more demand for the healthcare [3]. The aim of surgery is to improve functional ability and relieve symptoms with adequate decompression of the neural elements. Routine magnetic resonance imaging (MRI) is the standard method in the diagnostic workup of patients with suspected LSS [9,10]. Impacts of the MRI findings to the patients’ symptoms have been questioned [11]
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