The Relationship Between the Cross-sectional Area of the Cauda Equina and the Preoperative Symptoms in Central Lumbar Spinal Stenosis

Early postoperative MRI after spinal surgery is difficult to interpret because of confounding postoperative mass effects and frequent occurrence of epidural hematomas. Purpose of this prospective study is to evaluate prevalence, extent and significance of hematoma in the first postoperative week in asymptomatic patients after decompression for lumbar stenosis and to determine the degree of clinically significant dura compression by comparing with the patients with postoperative symptoms. MRI was performed in 30 asymptomatic patients (47 levels) in the first week after lumbar spine decompression for degenerative stenosis. Eleven patients requiring surgical revision (16 levels) for symptomatic early postoperative hematoma were used for comparison. In both groups the cross-sectional area of the maximum dural compression (bony stenosis and dural sac expansion) was measured preoperatively and postoperatively by an experienced radiologist. Epidural hematoma was seen in 42.5% in asymptomatic patients (20/47 levels). The median area of postoperative hematoma at the operated level was 176 mm 2 in asymptomatic patients and 365 mm 2 in symptomatic patients. The median cross-sectional area of the dural sac at the operated level was 128.5 and 0 mm 2 in asymptomatic and symptomatic patients, respectively, at the site of maximal compression. In the symptomatic group 75% of the patients had a maximal postoperative dural sac area of 58.5 mm 2 or less, whereas in the asymptomatic group 75% of patients with epidural hematoma had an area of 75 mm 2 or more. The size of hematoma and the degree of dural sac compression were significantly larger in patients with symptoms needing surgical revision. Dural sac area of less than 75 mm 2 in early postoperative MRI was found to be the threshold for clinical significance.

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“…Values below 100 mm 2 are generally accepted as stenosis and values below 75 mm 2 [14,[16][17][18][19] or 70 mm 2 [20,21] as absolute stenosis.…”

Section: Discussionmentioning

confidence: 99%

Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision

et al. 2010

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“…Using the Oswestry Disability Index (ODI), they found no significant correlation between the ODI percentage scores and central or lateral radiological stenosis (21). To the contrary, one study did find a correlation between spinal canal cross-sectional area and clinical symptoms; however, this was in preoperative patients with severe LSS (22). With most studies failing to show a correlation however, this study appears to be an exception.…”

Section: Im Ma Ag Gi In Ng Gmentioning

confidence: 46%

Electrodiagnosis in Lumbar Spinal Stenosis: A Review

Kishner¹,

Gündüz²,

Gupta³

et al. 2010

tftr

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S Su um mm ma ar ry yLumbar spinal stenosis (LSS) is a narrowing of the spinal canal and/or the neuroforamina through which the spinal cord roots enter and exit. The symptoms of LSS usually begin over the course of several months and include neurogenic claudication. This is characterized by low back pain that radiates down one or both legs producing pain or weakness. LSS can be quite debilitating and can have a profound negative effect on one's activities of daily living and overall quality of life. Imaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI) are routinely performed in the work-up of suspected LSS. In recent years, there has been much controversy over the actual clinical usefulness of these studies. When compared to electrodiagnostic studies, CT and MRI have been shown to have increased false negative and false positive rates. Electrodiagnostic studies show dynamic physiological neural function and has become a valuable tool in LSS. This information can be used to determine the location and severity of LSS, differentiate LSS from other conditions, and monitor the progression. Electrodiagnostic techniques such as somatosensory evoked potentials, dermatomal somatosensory evoked potentials (DSEPs), and paraspinal mapping (PM) increase both the sensitivity and specificity in diagnosing LSS. DSEPs provide useful information on multi-level, multiple rootlet disease. PM reflects the physiology of nerve roots and has been found to be superior to extremity needle EMG. Electrodiagnostic techniques are becoming the standard in the diagnosis and therapeutic decisions for LSS and other related diseases.Turk J Phys Med Rehab 2010;56:75-80. K Ke ey y W Wo or rd ds s: : Lumbar spinal stenosis, electrodiagnosis, low back pain, lumbar radiculopathy, paraspinal mapping Ö Öz ze et t Spinal kanalda ya da sinir köklerinin geçti¤i nöral foramenlerde daralma lomber spinal stenoz (LSS) olarak adland›r›l›r. LSS yaflam kalitesini belirgin derecede etkileyip engellili¤e neden olabilir. LSS'nin belirtileri aylar içinde ortaya ç›kar. Nörojenik klodikasyon, tek ya da her iki alt ekstremiteye yay›lan bel a¤r›s› ve güçsüzlük LSS'nin semptomlar› aras›nda say›labilir. LSS düflünülen olgularda bilgisayarl› tomografi (BT) ve manyetik rezonans görüntüleme (MRG) gibi yöntemler rutin olarak kullan›lmaktad›r. Fakat bu tetkiklerin LSS tan›s›na katk›s› ile ilgili tart›flma-lar giderek artmaktad›r. Elektrodiagnostik çal›flmalarla karfl›laflt›r›ld›-¤›nda BT ve MRG'nin yalanc› negatif ve yalanc› pozitiflikleri daha fazlad›r. Nöral fonksiyonlar›n gerçek zamanl› durumunu ortaya koyan elektrodiagnostik incelemeler LSS'de oldukça yararl›d›r. Elektrodiagnoz ayr›ca, LSS'nin lokalizasyonu ve fliddeti konusunda bilgi verir; hastal›¤›n ay›r›c› tan›s›nda ve progresyonunun takibinde de yararl›d›r. Somatosensoriyel uyand›r›lm›fl potansiyeller, dermatomal somatosensoriyel uyand›r›lm›fl potansiyeller (DSEP) ve paraspinal haritalama (PH) gibi elektrodiagnostik teknikler LSS tan›s›nda duyarl›l›k ve özgüllü¤ü artt›rmak-tad›r. DSEP,...

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“…Although imaging findings are evaluated and/or measured in most cases, the robust evidence for distinct connections between imaging findings and symptoms has remained elusive (Geisser et al 2007;Sirvanci et al 2008;Mattei 2013). However, some evidence exist for a more prounounced functional disability when the dural sac area is < 70 mm 2 (Athiviraham et al 2007;Ogikubo et al 2007).…”

Section: Imaging Symptoms and Outcomementioning

confidence: 99%

“…The studies by Schönström and later others and the advances in technology created greater knowledge, but still there is uncertainty in the relationship between the clinical symptoms and imaging techniques, including the measured area of the dural sac (Geisser et al 2007;Andreisek et al 2011;Mattei 2013). In spite of this, some evidence indicates that there is a critical threshold of a cross-sectional area of 70 mm 2 with lower values generally yielding inferior clinical functional status (Athiviraham et al 2007;Ogikubo et al 2007). However, there is an ongoing search for improved diagnostic methods for LSS (Andreisek 2011;Mattei 2013).…”

Section: Cross-sectional Imagingmentioning

confidence: 99%

Determinants of outcome in lumbar spinal stenosis surgery

Sigmundsson¹

2014

Acta Orthopaedica

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Cover illustration: "Spine Talk", acryl paint on stretched canvas. The painting was created in 2008 by the Canadian artist Barbara C. St Jean and is a painting of two people talking to each other over top of a spine of another. The painting was created to illustrate the problems associated with back pain and the discussions with medical professionals over the causes and treatment options. By permission from the artist.

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The Relationship Between the Cross-sectional Area of the Cauda Equina and the Preoperative Symptoms in Central Lumbar Spinal Stenosis

Abstract: The mCSA was a strong predictor of the preoperative walking ability, leg and back pain, and was directly related to the quality of life of patients with central spinal stenosis.

Cited by 120 publications

References 32 publications

Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision

Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision

Electrodiagnosis in Lumbar Spinal Stenosis: A Review

Determinants of outcome in lumbar spinal stenosis surgery

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