Predicting Lumbar Central Canal Stenosis – A Magnetic Resonance Imaging Study

Premchandran, Divya; Saralaya, Vasudha; Mahale, Ajit

doi:10.7860/jcdr/2014/8448.5097

Cited by 5 publications

(8 citation statements)

References 12 publications

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“…The SAC was defined as the difference between the sagittal diameter of the DS and the sagittal diameter of the corresponding SC for each level from C2 to C7 [6]. The TR was defined as the ratio of the sagittal diameter of the OSC and the sagittal diameter of the corresponding vertebral body for each level from C2 to C7 [13, 14, 19].…”

Section: Methodsmentioning

confidence: 99%

Reference values for the cervical spinal canal and the vertebral bodies by MRI in a general population

et al. 2019

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PurposeTo provide population-based reference values for cervical spinal canal parameters and vertebral body (VB) width and to study their associations with sex, age, body height, body weight and body mass index (BMI) using MRI.MethodsCross-sectional analyses included data from 2,453 participants, aged 21–89 years, of the population-based Study of Health in Pomerania (SHIP) who underwent whole-body MRI at 1.5 Tesla between July 2008 and March 2011. A standardised reading was performed for the C2-C7 cervical spine levels at sagittal T2 TSE weighted sequences.ResultsReference intervals for spinal canal parameters were similar in males and females, while VB width was on average 2.1–2.2 mm larger in males. Age effects were only substantial regarding VB width with a 0.5 mm per ten-year age increase. Body height effects were only substantial regarding the osseous spinal canal and VB width. Body weight and BMI effects are mostly not substantial.ConclusionsOur study provides MRI-based reference values for the cervical spinal canal parameters in an adult Caucasian population. Except for VB width, associations with sex, age and somatometric measures are mostly small and thus have only limited clinical implications. Some available cut-off values may need a revision because they likely overestimate risks.

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Section: Methodsmentioning

confidence: 99%

Reference values for the cervical spinal canal and the vertebral bodies by MRI in a general population

et al. 2019

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“…[ 3 , 5 , 10 ] LCCSS results from a decrease in the antero-posterior, transversal, or combined diameter secondary to hypertrophy of the facet joints, loss of disc height with or without herniation of the intervertebral disc, and hypertrophy of the ligamentum flavum. [ 11 ] The clinical diagnosis of LCCSS is currently based on clinical evaluation, history, and confirmatory imaging demonstrating central spinal canal narrowing. [ 23 , 24 ] The most frequently applied criteria were measurement of the anterior-posterior diameter of the cross-sectional area of the dural sac and of the osseous spinal canal for LCCSS.…”

Section: Discussionmentioning

confidence: 99%

“…[ 27 ] Another study demonstrated that the ratio between the DSCSA of the vertebral body can be used as a diagnostic marker to predict the occurrence of LCCSS. [ 11 ] Narrow DSCSA was significantly associated with the presence of low back pain after adjustment for body mass index, age, and sex. [ 28 ]…”

Section: Discussionmentioning

confidence: 99%

“…1 ) the dural sac was measured through the mid-point of the posterior border of the ligament flavum and disc on each side on axial T2 section of lumbar spine MRI scan. [ 11 ] To determine SCCSA (Fig. 2 ) the posterior line of the disc was followed, turning down to reach the lumbar facet joint side on the opposite edge.…”

Section: Methodsmentioning

confidence: 99%

“…Thus, the criteria for LCCSS should be compared from an analysis of a normative distribution of measurements. [ 10 , 11 ] In evaluating the severity LCCSS, dural sac cross-sectional area (DSCSA) and spinal canal cross-sectional area (SCCSA) are frequently measured by axial MRI. [ 12 – 18 ] Previous studies have indicated that smaller minimum DSCSA is directly associated with more back and leg pain, shorter walking distances before claudication, and lower health-related quality of life.…”

Section: Introductionmentioning

confidence: 99%

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Dural sac area is a more sensitive parameter for evaluating lumbar spinal stenosis than spinal canal area

et al. 2017

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Narrowing of the dural sac cross-sectional area (DSCSA) and spinal canal cross-sectional area (SCCSA) have been considered major causes of lumbar central canal spinal stenosis (LCCSS). DSCSA and SCCSA were previously correlated with subjective walking distance before claudication occurs, aging, and disc degeneration. DSCSA and SCCSA have been ideal morphological parameters for evaluating LCCSS. However, the comparative value of these parameters is unknown and no studies have evaluated the clinical optimal cut-off values of DSCSA and SCCSA. This study assessed which parameter is more sensitive.Both DSCSA and SCCSA samples were collected from 135 patients with LCCSS, and from 130 control subjects who underwent lumbar magnetic resonance imaging (MRI) as part of a medical examination. Axial T2-weighted MRI scans were acquired at the level of facet joint from each subject. DSCSA and SCCSA were measured at the L4-L5 intervertebral level on MRI using a picture archiving and communications system.The average DSCSA value was 151.67 ± 53.59 mm2 in the control group and 80.04 ± 35.36 mm2 in the LCCSS group. The corresponding average SCCSA values were 199.95 ± 60.96 and 119.17 ± 49.41 mm2. LCCSS patients had significantly lower DSCSA and SCCSA (both P < .001). Regarding the validity of both DSCSA and SCCSA as predictors of LCCSS, Receiver operating characteristic curve analysis revealed an optimal cut-off value for DSCSA of 111.09 mm2, with 80.0% sensitivity, 80.8% specificity, and an area under the curve (AUC) of 0.87 (95% confidence interval, 0.83–0.92). The best cut off-point of SCCSA was 147.12 mm2, with 74.8% sensitivity, 78.5% specificity, and AUC of 0.85 (95% confidence interval, 0.81–0.89).DSCSA and SCCSA were both significantly associated with LCCSS, with DSCSA being a more sensitive measurement parameter. Thus, to evaluate LCCSS patients, pain specialists should more carefully investigate the DSCSA than SCCSA.

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Variation of Torg-Pavlov ratio with age, gender, vertebral level, dural sac area, and ethnicity in lumbar magnetic resonance imaging

Qudsieh

Al-Rawashdeh

Daradkeh

et al. 2022

JCIS

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Objectives: The objectives of the study were to provide normal values of the Torg-Pavlov ratio (TPR) of the lumbar spine in magnetic resonance imaging (MRI) for the Jordanian population and examine differences observed according to factors including age, gender, lumbar level, dural sac area, or ethnic group. Material and Methods: Two hundred and eighteen lumbar MRIs from the Picture Archiving and Communication System were reviewed. These were collected from three main governmental hospitals, in North, Central, and South of Jordan. The mid-sagittal diameters of the vertebral body, spinal canal, and dural canal area were measured at all levels. Patients’ gender and age were documented as well. Exclusion criteria were kyphoscoliosis alignments disorders, lumbar spinal canal compression regardless of the cause, vertebral bony disease (including fractures), and the presence of technical artifacts. Statistical analyses used descriptive and correlational methods. Comparisons were made between genders, age groups, lumbar level, dural sac area in the study population using independent t-test and one-way ANOVA tests, and between ethnicities by reviewing previous reports on subjects of different ethnicities. Results: The mean TPR ratio for the study participants was 0.4502 ± 0.097. The value of TPR was widest in the 20–29-year-old group at all vertebral levels and in both males and females. Females had a significantly wider TPR than males (P = 0.003) in all age groups. TPR differed significantly between the five vertebral levels (P = 0.026). The difference in TPR between age groups was not statistically significant. TPR showed a positive significant correlation with dural sac (r = 0.203, P = 0.003). Comparison with the previous literature demonstrated variation in the TPR where Jordanian population had a lower TPR in comparison with Negros and Caucasoids whereas similar to Koreans, especially in females. Conclusion: There are significant differences in TPR according to gender, dural sac area, lumbar spinal level (except between L1 and L2), and ethnic group, but no significant difference with the age was found. The present study has identified normal values of Torg’s ratio in the Jordanian population. Although the study may not be able to provide clear guidelines for use in clinical practice, it has still highlighted possible between countries variations and has identified differences in these values to different factors. Implications on clinical practice could be reflected on the diagnosis of lumbar spinal stenosis or on predicting the prognosis of lumbar spine injury.

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Predicting Lumbar Central Canal Stenosis – A Magnetic Resonance Imaging Study

Cited by 5 publications

References 12 publications

Reference values for the cervical spinal canal and the vertebral bodies by MRI in a general population

Reference values for the cervical spinal canal and the vertebral bodies by MRI in a general population

Dural sac area is a more sensitive parameter for evaluating lumbar spinal stenosis than spinal canal area

Variation of Torg-Pavlov ratio with age, gender, vertebral level, dural sac area, and ethnicity in lumbar magnetic resonance imaging

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