Clinical correlation of a new practical MRI method for assessing central lumbar spinal stenosis

Abstract

Objective: To evaluate interobserver agreement and determine whether a new MRI grading system agrees with symptoms and neurological signs. Methods:We examined 160 patients (72 males and 88 females; mean age 57 years) who underwent MRI of the lumbar spine at our institution and were evaluated by two musculoskeletal radiologists. The presence and grade of central lumbar spinal stenosis (CLSS) at L3-4, L4-5 and L5-S1 were assessed according to a new grading system, the Lee system. The results were correlated with clinical manifestations and neurological examinations [positive neurological manifestation (PNM) and negative neurological manifestation (NNM)]. Statistical analyses were performed using kappa statistics and non-parametric correlation analysis (Spearman's correlation).Results: Interobserver agreement in the grading of CLSS between the two readers was substantial (k50.780). Interobserver agreement of the L4-5 level and older age group was high (0.789, 0.814). The correlation coefficient (R) of Reader 1 between MRI Grades 0, 1, 2 or 3 and neurological manifestations (negative or positive) was 0.654; the R of Reader 2 was 0.591. In the younger age group (,57 years), the R of Reader 1 was 0.634 and the R of Reader 2 was 0.500. In the older age group ($57 years), the R of Reader 1 was 0.650 and the R of Reader 2 was 0.645. Correlation coefficients were higher at the L3-4 level (0.612-0.678) than at other levels but did not show statistical significance (p.0.05). Conclusion:Interobserver agreement for the new CLSS grading system was substantial. Grade 0 was associated with NNMs and Grade 3 with PNMs in this cohort. Grade 2 demonstrates more cases of PNM than NNM but requires further evaluation. Correlations between MRI grades and clinical manifestations were moderate and slightly higher in older patients.

Optimal Cut-Off Value of the Superior Articular Process Area as a Morphological Parameter to Predict Lumbar Foraminal Stenosis

“…LCSS results from a combination of pathogenic factors, including a decrease in the area of the cauda equina, hypertrophy of ligamentum flavum, loss of intervertebral disk height, and hypertrophy of the facet joints [14]. LFS results from posterolateral osteophytes from the vertebral endplates, which protrude into the foramen along with a herniated disk or a laterally bulging annulus fibrosus.…”

A New MRI Grading System for Cervical Foraminal Stenosis Based on Axial T2-Weighted Images

“…The overall percentage agreements were also calculated. Agreement was rated as follows: kappa value interpretations were poor (κ < 0.1), slight (0.1 ≤ κ ≤ 0.2), fair (0.2 < κ ≤ 0.4), moderate (0.4 < κ ≤ 0.6), substantial (0.6 < κ ≤ 0.8), and nearly perfect (0.8 < κ ≤ 1.0) ( 19 21 ). Among the various guidelines for interpreting ICCs, we adapted a scale that was introduced in previous literature: ICC values of less than 0.40 indicate poor reproducibility, values of 0.40-0.75 indicate fair to good reproducibility, and values greater than 0.75 indicate excellent reproducibility ( 20 22 ).…”

Optimal cut-off points of lumbar pedicle thickness as a morphological parameter to predict lumbar spinal stenosis syndrome: a retrospective study

“… 10 , 11 LSSS results from multiple pathogenic risk factors, including a decrease in the area of the cauda equina, hypertrophy of LF, loss of intervertebral disk height and hypertrophy of the facet joints. 12 Several studies investigated the association between LF, dural sac area and spinal canal area on MRI and the signs and symptoms of LSSS. Park et al 13 reported that the LF is significantly thinner in patients with intervertebral disc herniation than in those with LSSS.…”