Usefulness of the Inferior Articular Process's Cross-Sectional Area as a Morphological Parameter for Predicting Central Lumbar Spinal Stenosis.

Sooho Lee,Young Uk Kim,Young-Seob Lim,Taeha Lim

doi:10.3390/jcm9010214

Abstract

Hypertrophy of facet joints is associated with a high risk of central lumbar spinal stenosis (CLSS). However, no research has reported the effect of inferior articular process hypertrophy in CLSS. We hypothesize that the inferior articular process’s cross-sectional area (IAPCSA) is larger in patients with CLSS compared to those without CLSS. Data on IAPCSA were obtained from 116 patients with CLSS. A total of 102 control subjects underwent lumbar spine magnetic resonance imaging (LS-MRI) as part of a routine medical examination. Axial T1-weighted images were obtained from the two groups. Using an imaging analysis system, we investigated the cross-sectional area of the inferior articular process. The average IAPCSA was 70.97 ± 13.02 mm2 in control subjects and 88.77 ± 18.52 mm2 in patients with CLSS. CLSS subjects had significantly greater levels of IAPCSA (p < 0.001) than controls. A receiver operating characteristic (ROC) curve was plotted to determine the validity of IAPCSA as a predictor of CLSS. The most suitable cut-off point of IAPCSA for predicting CLSS was 75.88 mm2, with a sensitivity of 71.6%, a specificity of 68.6%, and an area under the curve (AUC) of 0.78 (95% CI: 0.72–0.84). Greater IAPCSA levels were associated with a higher incidence of CLSS. These results demonstrate that IAPCSA is a useful morphological predictor in the evaluation of CLSS.

Highlights

Central lumbar spinal stenosis (CLSS) is the most common spinal disorder in patients aged 60 years and above [1]
CLSS is characterized by lumbar spinal canal narrowing that is caused by proliferation of the superior articular process, mechanical compression of the spinal nerve roots, hyperostosis of the vertebral posterior border, a hypertrophied ligamentum flavum, and protrusion of the intervertebral disc [7]
There was no significant difference in inferior articular process’s cross-sectional area (IAPCSA) among different age groups of control subjects based on one-way ANOVA (F = 1.79; df = 2; p = 0.172) (Table 2)

Summary

Introduction

Central lumbar spinal stenosis (CLSS) is the most common spinal disorder in patients aged 60 years and above [1]. The clinical manifestation of CLSS is chronic pain with a variable clinical manifestation that affects normal work and daily life and limits activity [2]. It presents with buttock pain, neurogenic intermittent claudication, and motor and sensory disturbances in the leg [2,3,4,5]. CLSS is characterized by lumbar spinal canal narrowing that is caused by proliferation of the superior articular process, mechanical compression of the spinal nerve roots, hyperostosis of the vertebral posterior border, a hypertrophied ligamentum flavum, and protrusion of the intervertebral disc [7]. To analyze the connection between CLSS and hypertrophied IAP, we investigated the inferior articular process’s cross-sectional area (IAPCSA). We used lumbar spine magnetic resonance imaging (LS-MRI) to compare the IAPCSA between normal subjects and CLSS patients

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Discussion

Conclusion