Dural sac cross-sectional area and morphological grade show significant associations with patient-rated outcome of surgery for lumbar central spinal stenosis

Mannion, Anne F.; Fekete, Tamás; Pacifico, D.; O’Riordan, Dave; Nauer, Selina; Büren, Moritz von; Schizas, Constantin

doi:10.1007/s00586-017-5280-7

Cited by 34 publications

(35 citation statements)

References 41 publications

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“…One recent direct comparison showed no relevant difference between cross-sectional area measurement of the dural sac and morphological classification of spinal stenosis regarding their association with patient-rated outcome of spinal surgery for stenosis in 157 patients. 29 The authors did, however, spell out the advantages of morphological grading in the sense that no specific tools are required and classification can be performed in an instant. Yet, the literature on this topic is still scarce and further research is warranted.…”

Section: Observer Kappamentioning

confidence: 99%

Interobserver Reliability When Classifying MR Imaging of the Lumbar Spine: Written Instructions Alone Do Not Suffice

Hofmann

Keller

Gesicki

et al. 2020

MRMS

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Numerous classification systems have been proposed to analyze lumbar spine MRI scans. When evaluating these systems, most studies draw their conclusions from measurements of experienced clinicians. The aim of this study was to evaluate the impact of specific measurement training on interobserver reliability in MRI classification of the lumbar spine. Methods: Various measurement and classification systems were assessed for their interobserver reliability in 30 MRIs from patients with chronic lumbar back and sciatic pain. Two observers were experienced spine surgeons. The third observer was an inexperienced medical student who, prior to the study measurements, in addition to being given the detailed written instructions also given to the surgeons, obtained a list of 20 reference measurements in MRI scans from other patients to practice with. Results: Excellent agreement was observed between the medical student and the spine surgeon who had also created the reference measurements. Between the two spine surgeons, agreement was markedly lower in all systems investigated (e.g., antero-posterior spinal canal diameter intraclass correlation coefficient [ICC] [3.1] = 0.979 vs. ICC [3.1] = 0.857). Conclusion: These data warrant the creation of publicly available standardised measurement examples of accepted classification systems to increase reliability of the interpretation of MR images.

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Section: Observer Kappamentioning

confidence: 99%

Interobserver Reliability When Classifying MR Imaging of the Lumbar Spine: Written Instructions Alone Do Not Suffice

Hofmann

Keller

Gesicki

et al. 2020

MRMS

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“…To our knowledge, no study comparing postoperative DSCSA changes between COS and MIS has been published. DSCSA has been reported to be significantly associated with clinical outcomes after surgery for lumbar spinal canal stenosis [24]. Our evaluation of postoperative DSCSA changes indicated better decompression in the COS group than the MIS group.…”

Section: Discussionmentioning

confidence: 55%

Comparison of Paraspinal Muscle Degeneration and Decompression Effect Between Conventional Open and Minimal Invasive Approaches for Posterior Lumbar Spine Surgery: a prospective cohort study.

Chen

et al. 2020

Preprint

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Background Posterior Instrumented Transforaminal Lumbar Interbody Fusion (TLIF) is used to treat spinal stenosis. Minimally invasive surgery (MIS) can cause less muscle injury than conventional open surgery (COS) The purpose of this study was to compare the degree of postoperative fatty degeneration in the paraspinal muscles and the spinal decompression between COS and MIS based on magnetic resonance imaging (MRI). Methods Forty-six patients received TLIF (21 COS, 25 MIS) from February 2016 to January 2017. Lumbar MRI was performed within 3 months before surgery and 1 year after surgery. The postoperative muscle-fat-index (MFI) change of the paraspinal muscles (multifidus and erector spinae) and the dural sac cross-sectional area (DSCAS) change were compared between the 2 groups. Results The average MFI change at L2-S1 erector spinae muscle was significantly greater in the COS group (27.37 ± 21.37% vs. 14.13 ± 19.19%, P = 0.044). A significant MFI change difference between the COS and MIS group was also found in the erector spinae muscle at the caudal adjacent level (54.47 ± 37.95% vs. 23.60 ± 31.59%, P = 0.016). No significant differences at the operated and cranial adjacent level were found. DSCSA improvement after surgery was significantly greater in the COS group (128.15 ± 39.83 mm2 vs. 78.15 ± 38.5 mm2, P = 0.0005) Conclusion COS is associated with more prominent fatty degeneration of the paraspinal muscles. Statically significant post-operative MFI change was only noted in erector spinae muscle at caudal adjacent level and L2-S1 mean global level. COS produces a greater decompressive effect than MIS.

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“…Wada et al 20 noted improvement in the area of the dural tube at the level of compression to 408% after endoscopic decompression. Due to its excellent interobserver reliability and usage in the published literature, we utilized the Schizas qualitative measure, 11,17,18 rather than quantitative measures such as dural sac cross-sectional area or stenosis ratio, to measure central stenosis on MRI.…”

Section: Discussionmentioning

confidence: 99%

Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

Khalsa

Kim

Singh

et al. 2019

Neurosurgical Focus

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OBJECTIVELumbar central stenosis can theoretically be decompressed with minimal bone removal via an endoscopic approach. Although multiple studies have demonstrated an adequate radiographic decompression, none has quantified the volume of bone removal after endoscopic decompression. The objective of this study was to quantify the 3D volume of bone removed from the lamina and facet joints during endoscopic decompression for lumbar central and lateral recess stenosis.METHODSThis retrospective study included adults with lumbar spinal stenosis who underwent endoscopic decompression of a single level or 2 noncontiguous lumbar levels. Central stenosis on MRI was graded preoperatively and postoperatively using the Schizas scale. A computer program was developed in MATLAB to semiautomatically perform a 3D volumetric analysis of preoperative and postoperative lumbar CT scans. The volumetric percentage of bone removed from the lamina and facet joints ipsilateral and contralateral to the side of approach was quantified.RESULTSNineteen patients with 21 treated lumbar levels were included in the study. Preoperatively, the number of levels with Schizas stenosis grades B, C, and D were 5, 12, and 4, respectively. Stenosis grades improved postoperatively to grades A, B, C, and D for 17, 3, 1, and 0 levels, respectively. All levels improved by at least 1 stenosis grade. The volumetric percentage of laminar bone removed was 15.5% (95% CI 11.2%–19.8%, p < 0.001) from the ipsilateral lamina and 8.8% (95% CI 5.7%–11.8%, p < 0.001) from the contralateral lamina. The percentage of facet joint resection was 5.3% (95% CI 4.2%–6.4%, p < 0.001) and 4.3% (95% CI 2.2%–6.4%, p < 0.001) for the ipsilateral and contralateral facet joints, respectively. Average pain scores, as measured by the visual analog scale, improved from 7.9 preoperatively to 2.2 by 3–10 months postoperatively (p < 0.001).CONCLUSIONSEndoscopic lumbar decompression achieves improvement in the radiographic grade of lumbar central stenosis with minimal bone removal from the lamina and facet joints. Future prospective studies are needed to validate the findings of this study with more comprehensive clinical outcomes.

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Dural sac cross-sectional area and morphological grade show significant associations with patient-rated outcome of surgery for lumbar central spinal stenosis

Cited by 34 publications

References 41 publications

Interobserver Reliability When Classifying MR Imaging of the Lumbar Spine: Written Instructions Alone Do Not Suffice

Interobserver Reliability When Classifying MR Imaging of the Lumbar Spine: Written Instructions Alone Do Not Suffice

Comparison of Paraspinal Muscle Degeneration and Decompression Effect Between Conventional Open and Minimal Invasive Approaches for Posterior Lumbar Spine Surgery: a prospective cohort study.

Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

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