Reducing surgical levels by paraspinal mapping and diffusion tensor imaging techniques in lumbar spinal stenosis.

Hua-Biao Chen,Qi-Feng Xu,Yi Chen,Qi Wan,Bo Bai

doi:10.1186/s13018-016-0382-1

Abstract

BackgroundCorrelating symptoms and physical examination findings with surgical levels based on common imaging results is not reliable. In patients who have no concordance between radiological and clinical symptoms, the surgical levels determined by conventional magnetic resonance imaging (MRI) and neurogenic examination (NE) may lead to a more extensive surgery and significant complications. We aimed to confirm that whether the use of diffusion tensor imaging (DTI) and paraspinal mapping (PM) techniques can further prevent the occurrence of false positives with conventional MRI, distinguish which are clinically relevant from levels of cauda equina and/or nerve root lesions based on MRI, and determine and reduce the decompression levels of lumbar spinal stenosis than MRI + NE, while ensuring or improving surgical outcomes.MethodsWe compared the data between patients who underwent MRI + (PM or DTI) and patients who underwent conventional MRI + NE to determine levels of decompression for the treatment of lumbar spinal stenosis. Outcome measures were assessed at 2 weeks, 3 months, 6 months, and 12 months postoperatively.ResultsOne hundred fourteen patients (59 in the control group, 54 in the experimental group) underwent decompression. The levels of decompression determined by MRI + (PM or DTI) in the experimental group were significantly less than that determined by MRI + NE in the control group (p = 0.000). The surgical time, blood loss, and surgical transfusion were significantly less in the experimental group (p = 0.001, p = 0.011, p = 0.001, respectively). There were no differences in improvement of the visual analog scale back and leg pain (VAS-BP, VAS-LP) scores and Oswestry Disability Index (ODI) scores at 2 weeks, 3 months, 6 months, and 12 months after operation between the experimental and control groups.ConclusionsMRI + (PM or DTI) showed clear benefits in determining decompression levels of lumbar spinal stenosis than MRI + NE. In patients with lumbar spinal stenosis, the use of PM and DTI techniques reduces decompression levels and increases safety and benefits of surgery.

Highlights

Correlating symptoms and physical examination findings with surgical levels based on common imaging results is not reliable
We hypothesized that the use of diffusion tensor imaging (DTI) and paraspinal mapping (PM) techniques can further prevent the occurrence of false positives with conventional magnetic resonance imaging (MRI), distinguish which are clinically relevant from levels of cauda equina and/or nerve root lesions based on MRI, and determine and reduce the decompression levels of lumbar spinal stenosis than MRI + neurogenic examination (NE), while ensuring or improving surgical outcomes
The levels of decompression determined by MRI + (PM or DTI) in the experimental group were statistically significantly less than that determined by MRI + NE in the control group (p = 0.000) (Table 7)

Summary

Introduction

Correlating symptoms and physical examination findings with surgical levels based on common imaging results is not reliable. The extent of narrowing of the spinal canal correlates poorly with symptom severity, and radiologically significant lumbar spinal stenosis can be found in asymptomatic individuals [4,5,6,7]. As a consequence, correlating symptoms and physical examination findings with decompression levels based on common imaging results is not reliable. In patients who have no concordance between radiological and clinical symptoms, the surgical levels determined by conventional magnetic resonance imaging (MRI) and neurogenic examination (NE) may lead to a more extensive surgery and significant complications. It is important to avoid inadequacies of MRI (MRI cannot precisely determine the lesion levels of lumbar spinal stenosis) in clinical practice

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