Electromyographic and Magnetic Resonance Imaging to Predict Lumbar Stenosis, Low-Back Pain, and No Back Symptoms

Haig, Andrew J.; Geisser, Michael E.; Tong, Henry C.; Yamakawa, Karen; Quint, Douglas J.; Hoff, Julian T.; Chiodo, Anthony; Miner, Jennifer A.; Phalke, Vaishali V.

doi:10.2106/jbjs.e.00704

Cited by 120 publications

(97 citation statements)

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“…The pathology of this disease is most typically due to degenerative changes. Haig et al 11 and Geisser et al 12 demonstrated that there was little relationship between central canal size and clinical symptoms among individuals with a clinical diagnosis of lumbar spinal stenosis. Amonoo-Kuofi et al 13 and Agur 14 have reported a small and triangular vertebral foramina with "pinched" lateral angles at L5.…”

Section: Introductionmentioning

confidence: 99%

“…The mean width of the vertebral foramen (as determined in dry bone and radiological study) was ranged between 21.6 to 25.1 mm. Haig et al, 11 Weinstein, 23 Verbiest, 24 and Jane et al 25 noted that lumbar canal width, ranging from 10 to 12 mm might be associated with claudication if additional soft or hard tissue elements encroached on the canal, and they referred to this type of stenosis as "relative" canal stenosis. The diameters observed in the present study were in contrary to those of Williams et al 26 who reported a gradual decrease in measurement between L1 and L5 level, with a greater relative width in females, however, the present study did not show any significant differences in the average widths (means) of lumbar vertebral foramina between males and females.…”

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confidence: 99%

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Lumbar vertebral canal stenosis: concept of morphometric and radiometric study of the human lumbar vertebral canal

El-Rakhawy¹

2010

Anatomy

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Objectives: Vertebral canal stenosis has attracted the attention of anatomists and clinician as an important structural change with significant radiological and clinical implications. Narrowing of all diameters of the vertebral foramen with age could be responsible as a factor which might produce back pain. The aim of the present study was to estimate the averages anatomical changes in the transverse and anteroposterior diameters of the lumbar vertebral canal in Egyptian population to establish a clue to the underlying some causes of the low-back pain of unknown etiology. Methods:The present study investigated the lumbar part of the vertebral column of 20 adult skeletons and 200 plain Xrays of normal living subjects (100 males and 100 females) for both morphometric and radiometric analyses. Results:The mean width of the body of vertebrae showed gradual increase with the exception at L4 in dry bones. In addition, the mean width and depth of the vertebral foramina showed a gradual increase with the exception of L3 in dry bones. The study recorded a positive relationship between the mean width of the vertebral foramen and that of the body. The mean vertebral foramen width/body ratio was 0.6 except at L3 and L5 where the ratio was 0.5. Conclusion:The present study has shown a narrower depth of the lumbar vertebral canal in Egyptian population. L3 remains the center point for transition in the dimensions and hence more susceptible to stenosis and spinal nerve compression. This study has also shown that the ratio between the width of body and foramen of lumbar vertebrae remains constant. By this ratio it may be possible to predict any lumbar vertebral anomalies or vertebral canal stenoses and to give some explanation about low-back pain of unknown etiology.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Lumbar vertebral canal stenosis: concept of morphometric and radiometric study of the human lumbar vertebral canal

El-Rakhawy¹

2010

Anatomy

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“…In various studies conducted by Bolender [12], Lee [13] and Haig [14] wherein the spinal canal diameter was measured. They established cut off values in order to diagnose stenosis, <13mm, <10mm and <11.95mm respectively.…”

Section: Discussionmentioning

confidence: 99%

Predicting Lumbar Central Canal Stenosis – A Magnetic Resonance Imaging Study

Premchandran

Saralaya

Mahale

2014

JCDR

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“…This is because the presence of LSS on magnetic resonance imagig (MRI) or computed tomography (CT) scans has been shown to poorly correlate with lower extremity symptoms. [12][13][14][15][16][17][18] Similarly, not all patients with PVD, demonstrated by their arterial brachial index (ABI) measurement on a Doppler ultrasound, have claudication symptoms. 19,20 Moreover, both LSS and PVD can coexist in the same patient, and imaging studies are unhelpful in deciding which must be treated for relief of their claudication symptoms.…”

Section: Verbiestmentioning

confidence: 99%

The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation

Nadeau

Rosas‐Arellano

Gurr

et al. 2013

CJS

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Background: Intermittent claudication can be neurogenic or vascular. Physicians use a profile based on symptom attributes to differentiate the 2 types of claudication, and this guides their investigations for diagnosis of the underlying pathology. We evaluated the validity of these symptom attributes in differentiating neurogenic from vascular claudication. Methods:Patients with a diagnosis of lumbar spinal stenosis (LSS) or peripheral vascular disease (PVD) who reported claudication answered 14 questions characterizing their symptoms. We determined the sensitivity, specificity and positive and negative likelihood ratios (PLR and NLR) for neurogenic and vascular claudication for each symptom attribute. Results:We studied 53 patients. The most sensitive symptom attribute to rule out LSS was the absence of "triggering of pain with standing alone" (sensitivity 0.97, NLR 0.050). Pain alleviators and symptom location data showed a weak clinical significance for LSS and PVD. Constellation of symptoms yielded the strongest associations: patients with a positive shopping cart sign whose symptoms were located above the knees, triggered with standing alone and relieved with sitting had a strong likelihood of neurogenic claudication (PLR 13). Patients with symptoms in the calf that were relieved with standing alone had a strong likelihood of vascular claudication (PLR 20.0). Conclusion:The classic symptom attributes used to differentiate neurogenic from vascular claudication are at best weakly valid independently. However, certain constellation of symptoms are much more indicative of etiology. These results can guide general practitioners in their evaluation of and investigation for claudication.Contexte : La claudication intermittente peut avoir une étiologie neurogène ou vasculaire. Les médecins utilisent un profil fondé sur les particularités des symptômes pour distinguer l'une de l'autre et ceci oriente leur choix des méthodes de diagnostic de la pathologie sous-jacente. Nous avons évalué la validité de ces particularités des symptômes utilisées pour distinguer la claudication d'origine neurogène de la claudication d'origine vasculaire. Méthodes :Des patients atteints d'une sténose spinale lombaire (SSL) ou d'une maladie vasculaire périphérique (MVP) avérées qui se plaignaient de claudication ont répondu à 14 questions afin de caractériser leurs symptômes. Nous avons déterminé la sensibilité, la spécificité et les rapports de probabilité positifs et négatifs (RPP et RPN) à l'égard de la claudication neurogène ou vasculaire pour chacune des particularités des symptômes.Résultats : Notre étude a regroupé 53 patients. La particularité des symptômes dotée de la sensibilité la plus élevée pour ce qui est d'écarter le diagnostic de SSL a été l'absence de « déclenchement de la douleur à la simple station debout » (sensibilité 0,97; RPN 0,050). Les données sur ce qui soulageait la douleur et sur la localisation des symptômes ont eu une faible portée clinique en ce qui a trait à la SSL et à la MVP. La présence d'une constellati...

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Electromyographic and Magnetic Resonance Imaging to Predict Lumbar Stenosis, Low-Back Pain, and No Back Symptoms

Cited by 120 publications

References 46 publications

Lumbar vertebral canal stenosis: concept of morphometric and radiometric study of the human lumbar vertebral canal

Lumbar vertebral canal stenosis: concept of morphometric and radiometric study of the human lumbar vertebral canal

Predicting Lumbar Central Canal Stenosis – A Magnetic Resonance Imaging Study

The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation

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