Visually assessed severity of lumbar spinal canal stenosis is paradoxically associated with leg pain and objective walking ability

Kuittinen, Pekka; Sipola, Petri; Saari, Tapani; Aalto, Timo; Sinikallio, Sanna; Savolainen, Sakari; Kröger, Heikki; Turunen, Veli; Leinonen, Ville; Airaksinen, Olavi

doi:10.1186/1471-2474-15-348

Cited by 44 publications

(33 citation statements)

References 33 publications

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“…Since this is the first study to evaluate this correlation, no references are available to state these results. Similar studies have been performed for other spinal diseases such as sciatica [12] or lumbar spinal stenosis [11,19–21], displaying no correlation between imaging and clinical features, being in line with the current study. The suggestion that factors other than the spinal canal size alone, such as local neurovascular problems, venous obstruction or effect of local inflammatory cytokines–factors that are not identifiable at conventional MRI–contribute to differences in clinical manifestation of CES, seems sensible [18].…”

Section: Discussionsupporting

confidence: 92%

Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients

et al. 2017

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IntroductionCorrelation between magnetic resonance imaging (MRI) and clinical features in cauda equina syndrome (CES) is unknown; nor is known whether there are differences in MRI spinal canal size between lumbar herniated disc patients with CES versus lumbar herniated discs patients without CES, operated for sciatica. The aims of this study are 1) evaluating the association of MRI features with clinical presentation and outcome of CES and 2) comparing lumbar spinal canal diameters of lumbar herniated disc patients with CES versus lumbar herniated disc patients without CES, operated because of sciatica.MethodsMRIs of CES patients were assessed for the following features: level of disc lesion, type (uni- or bilateral) and severity of caudal compression. Pre- and postoperative clinical features (micturition dysfunction, defecation dysfunction, altered sensation of the saddle area) were retrieved from the medical files. In addition, anteroposterior (AP) lumbar spinal canal diameters of CES patients were measured at MRI. AP diameters of lumbar herniated disc patients without CES, operated for sciatica, were measured for comparison.Results48 CES patients were included. At MRI, bilateral compression was seen in 82%; complete caudal compression in 29%. MRI features were not associated with clinical presentation nor outcome. AP diameter was measured for 26 CES patients and for 31 lumbar herniated disc patients without CES, operated for sciatica. Comparison displayed a significant smaller AP diameter of the lumbar spinal canal in CES patients (largest p = 0.002). Compared to average diameters in literature, diameters of CES patients were significantly more often below average than that of the sciatica patients (largest p = 0.021).ConclusionThis is the first study demonstrating differences in lumbar spinal canal size between lumbar herniated disc patients with CES and lumbar herniated disc patients without CES, operated for sciatica. This finding might imply that lumbar herniated disc patients with a relative small lumbar spinal canal might need to be approached differently in managing complaints of herniated disc. Since the number of studied patients is relatively small, further research should be conducted before clinical consequences are considered.

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Section: Discussionsupporting

confidence: 92%

Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients

et al. 2017

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“…It has already been shown in the literature that the ODI did not have a significant relationship with the area of the cross-section of the dural sac, or with the narrowing observed in radiological studies either in patients with and without spondylolisthesis. 12,26,27 The relationship was inversely proportional in the SSF-36. 17 However, there was no statistically significant correlation in this study, taking the PCS and MCS into account.…”

Section: Discussionmentioning

confidence: 93%

Correlation Between Lumbar Spinal Stenosis Based on Morphology of the Dural Sac and the Quality of Life

Verde

Neto

et al. 2019

Coluna/Columna

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Objective: To evaluate the possible existence of a significant correlation between quality of life and severity classification of lumbar stenosis based on dural sac morphology in outpatients. Methods: Forty patients with a diagnosis of lumbar stenosis followed at a university hospital were submitted to magnetic resonance imaging (MRI) and quality of life questionnaires: Oswestry Disability Index (ODI), SF-36, Swiss Spinal Stenosis Questionnaire (SSS) and EQ-5D. They were classified as type A, B, C or D based on MRI. For the statistical analysis, the Spearman correlation was used. Results: Seventeen female patients and 23 male patients with mean age of 56.5 years constituted the sample. ODI had a mean dysfunction of 44.9%, the PCS score averaged 29.9, the MCS score was 41.3. The general symptoms of SSS presented a mean of 3.2 and the EQ-5D presented an average of 0.491. The patients with the highest severity in the classification were not necessarily those who presented worse scores in the quality of life questionnaires. Conclusion: The classification of severity of the lumbar spinal stenosis based on dural sac morphology does not correlate with the applied quality of life questionnaires. Level of Evidence III; Cross-sectional observational study.

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“…Chronic and neuropathic pain are particularly associated with cognitive impairment [7,8]. A past report showed that severe pain led to cognitive impairment in a longitudinal study [3]. We showed that neuropathic pain and numbness due to LDD were associated with cognitive dysfunction.…”

Section: The Relationship Between Ldd and Cognitive Functionmentioning

confidence: 56%

“…Lumbar degenerative disease (LDD), such as lumbar spinal stenosis (LSS), degenerative spondylolisthesis and spondylosis deformity, is more prevalent among middle-aged and elderly individuals. LDD causes low back pain, intermitted claudication, bladder and rectal disturbance, numbness and lower limb pain, and deterioration in muscle power of the lower limbs as well as standing and walking abilities [1][2][3]. The number of people whose quality of life (QOL) is impaired by LDD is expected to increase in a super-aging society.…”

Section: Introductionmentioning

confidence: 99%

Associations Between Symptoms and Quality of Life in Lumbar Degenerative Disease and Cognitive Dysfunction in a Japanese Community: A Cross-sectional Study

Koyama

Wada

Kumagai

et al. 2020

Preprint

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Background: Lumbar degenerative disease (LDD) and dementia are increasing in super-aging societies and are both related to physical dysfunction and pain. However, the relationship between these diseases remains unclear. This cross-sectional study aimed to investigate the rate of comorbidity of lumbar spinal stenosis (LSS) and mild cognitive impairment (MCI) by age and sex and clarify the association between LSS presence, LDD symptoms, quality of life (QOL) related to low back pain, and cognitive impairment in a Japanese population.Methods: We enrolled 1097 participants (men 437; women 660; mean age 54.6 years) from a medical checkup program. LSS was diagnosed using a self-administered questionnaire, and LDD symptoms were evaluated using visual analog scale (VAS: low back pain, pain, numbness of the lower limb). QOL related to low back pain was evaluated using the Japanese Orthopedic Association Back-Pain Evaluation Questionnaire (JOABPEQ: pain, lumbar function, and gait function), and Kellgren-Lawrence grading was performed to evaluate lumbar degeneration using lateral radiographs of the lumbar spine. Cognitive function was measured using the Mini Mental State Examination (MMSE), and we defined MCI as a summary score of MMSE £27. Logistic and multiple liner regression analyses were performed to analyze the association between MCI, summary score of MMSE and LSS factors.Results: The comorbidity rate of MCI and LSS was 0.9% in men and 0.7% in women. It was 2.1% in those aged ³65 years in both sexes, and this rate increased with age. Lumbar function in JOABPEQ (OR 0.979, 95% CI 0.961 to 0.998) and lower limb pain in VAS (OR 1.020, 95% CI 1.002 to 1.039) were associated with MCI in men. The presence of LSS, lumbar function, and gait function in JOABPEQ were associated with MMSE in both sexes, while lower limb numbness and pain in VAS were associated with MMSE in men.Conclusion: The comorbidity rate of LSS and MCI increased with age. The presence of LSS, certain symptoms of LDD, and deterioration of QOL due to low back pain were related to cognitive dysfunction. Treatment of LDD could help to improve both LDS symptoms and cognitive dysfunction.

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Visually assessed severity of lumbar spinal canal stenosis is paradoxically associated with leg pain and objective walking ability

Cited by 44 publications

References 33 publications

Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients

Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients

Correlation Between Lumbar Spinal Stenosis Based on Morphology of the Dural Sac and the Quality of Life

Associations Between Symptoms and Quality of Life in Lumbar Degenerative Disease and Cognitive Dysfunction in a Japanese Community: A Cross-sectional Study

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