Is There an Association Between Pain and Magnetic Resonance Imaging Parameters in Patients With Lumbar Spinal Stenosis?

Burgstaller, Jakob M; Schüffler, Peter J.; Buhmann, Joachim M.; Andreisek, Gustav; Winklhofer, Sebastian; Grande, Filippo Del; Mattle, Michèle; Brunner, Florian; Karakoumis, Georgios; Steurer, Johann; Held, Ulrike

doi:10.1097/brs.0000000000001544

Cited by 46 publications

(31 citation statements)

References 43 publications

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“…The symptoms of LSS often poorly correlate with their radiological findings and many asymptomatic persons even showed severe narrowing of spinal canal in MRI 18. In a multi-center cohort study, Burgstaller didn’t find any correlation between MRI findings and the severity of symptoms either 6. In the current study, we had the similar results.…”

Section: Discussionsupporting

confidence: 77%

“…Some authors also have the same conclusion in their studies on conservative treatment of degenerative LSS, but they performed other conservative methods instead of CSE5. Although some authors suggest that there is a need for innovative methods or techniques to detect the causal relationship between radiological findings and the complaints of patients with LSS,6 we attributed the clinical outcomes to the same effect of CSE on lumbar alignment in this study.…”

Section: Discussionmentioning

confidence: 75%

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Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis?

Chen

Lin

Zhang³

et al. 2017

Pak J Med Sci

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Objective:To determine whether the effectiveness of core stability exercises correlates with the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis.Methods:Forty-two patients with degenerative lumbar spinal stenosis treated in the department of orthopedics of our hospital between May 2013 and January 2016 were included in the study. All the patients performed core stability exercises once daily for six weeks, and the clinical outcomes were evaluated using Japanese Orthopaedic Association (JOA) score and self-reported walking capacity. The anteroposterior osseous spinal canal diameter was measured to evaluate the severity of spinal stenosis. The correlation between the stenosis degree and the differences of Japanese Orthopaedic Association score or self-reported walking capacity at baseline and after treatment were analyzed.Results:The patients were divided into three groups according to the spinal stenosis degree. In the three groups, there was no significant difference in JOA or self-reported walking distance at baseline (p>0.05) and after treatment (p>0.05). The JOA scores and self-reported walking distance were significantly increased after treatment (p<0.05) in any of the three groups when compared to the baseline. Also, there was no significant correlation between the stenosis degree and the difference of JOA (p>0.05) or self-reported walking distance (p>0.05).Conclusion:There was no significantcorrelation between the effectiveness of core stability exercises and the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 75%

Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis?

Chen

Lin

Zhang³

et al. 2017

Pak J Med Sci

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“…Another study found no clinically important improvement in symptoms and function after surgery in 57% of patients 40 . Moreover, recent research has found no association between magnetic resonance imaging radiological findings and the severity of buttock, leg and back pain, even when analysis was restricted to the level of the spine with the most prominent radiological stenosis 41 …”

Section: Diagnostic Triage For Primary Care Management Of Low Back Painmentioning

confidence: 96%

Diagnostic triage for low back pain: a practical approach for primary care

Bardin

King²,

Maher³

2017

Medical Journal of Australia

238

149

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Diagnostic triage is an essential guideline recommendation for low back pain (LBP), which is the most frequent musculoskeletal condition that general practitioners encounter in Australia. Clinical diagnosis of LBP - informed by a focused history and clinical examination - is the key initial step for GPs, and determines subsequent diagnostic workup and allied health and medical specialist referral. The goal of diagnostic triage of LBP is to exclude non-spinal causes and to allocate patients to one of three broad categories: specific spinal pathology (< 1% of cases), radicular syndrome (∼ 5-10% of cases) or non-specific LBP (NSLBP), which represents 90-95% of cases and is diagnosed by exclusion of the first two categories. For specific spinal pathologies (eg, vertebral fracture, malignancy, infection, axial spondyloarthritis or cauda equina syndrome), a clinical assessment may reveal the key alerting features. For radicular syndrome, clinical features distinguish three subsets of nerve root involvement: radicular pain, radiculopathy and spinal stenosis. Differential diagnosis of back-related leg pain is complex and clinical manifestations are highly variable. However, distinctive clusters of characteristic history cues and positive clinical examination signs, particularly from neurological examination, guide differential diagnosis within this triage category. A diagnosis of NSLBP presumes exclusion of specific pathologies and nerve root involvement. A biopsychosocial model of care underpins NSLBP; this includes managing pain intensity and considering risk for disability, which directs matched pathways of care. Back pain is a symptom and not a diagnosis. Careful diagnostic differentiation is required and, in primary care, diagnostic triage of LBP is the anchor for a diagnosis.

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“…There are many reasons for uncertainty in the radiographic diagnosis of LSS. There are abundant proposed grading systems, but unfortunately, no single system has proven superior, creating inconsistencies in the literature . There are measurable, quantitative criteria, but more commonly, qualitative criteria are used, leading to inconsistent inter‐reader agreement .…”

Section: Lumbar Spinal Stenosismentioning

confidence: 99%

“…There are abundant proposed grading systems, but unfortunately, no single system has proven superior, creating inconsistencies in the literature. 13,14 There are measurable, quantitative criteria, but more commonly, qualitative criteria are used, leading to inconsistent inter-reader agreement. 15 Another complication to reaching the elusive diagnosis of LSS is that multiple imaging modalities are employed.…”

Section: Diagnosis Of Lumbar Spinal Stenosis By Radiologic Imagingmentioning

confidence: 99%

The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment

Deer¹,

Grider

Pope

et al. 2018

Pain Practice

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Background Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options. Methods The Lumbar Spinal Stenosis Consensus Group convened to evaluate the peer‐reviewed literature as the basis for making minimally invasive spine treatment (MIST) recommendations. Eleven consensus points were clearly defined with evidence strength, recommendation grade, and consensus level using U.S. Preventive Services Task Force criteria. The Consensus Group also created a treatment algorithm. Literature searches yielded 9 studies (2 randomized controlled trials [RCTs]; 7 observational studies, 4 prospective and 3 retrospective) of minimally invasive spine treatments, and 1 RCT for spacers. Results The LSS treatment choice is dependent on the degree of stenosis; spinal or anatomic level; architecture of the stenosis; severity of the symptoms; failed, past, less invasive treatments; previous fusions or other open surgical approaches; and patient comorbidities. There is Level I evidence for percutaneous image‐guided lumbar decompression as superior to lumbar epidural steroid injection, and 1 RCT supported spacer use in a noninferiority study comparing 2 spacer products currently available. Conclusions MISTs should be used in a judicious and algorithmic fashion to treat LSS, based on the evidence of efficacy and safety in the peer‐reviewed literature. The MIST Consensus Group recommend that these procedures be used in a multimodal fashion as part of an evidence‐based decision algorithm.

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Is There an Association Between Pain and Magnetic Resonance Imaging Parameters in Patients With Lumbar Spinal Stenosis?

Cited by 46 publications

References 43 publications

Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis?

Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis?

Diagnostic triage for low back pain: a practical approach for primary care

The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment

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