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Article: Defining clinically relevant values for developmental spinal stenosis: a large-scale magnetic resonance imaging study

TitleDefining clinically relevant values for developmental spinal stenosis: a large-scale magnetic resonance imaging study
Authors
Issue Date2014
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
Citation
Spine, 2014, v. 39 n. 13, p. 1067-1076 How to Cite?
AbstractSTUDY DESIGN: Case-control study. OBJECTIVE: The aim of this study was to define clinically relevant relative and critical (absolute) magnetic resonance imaging values of lumbar spinal stenosis in a cohort of 100 surgical cases and 100 asymptomatic controls. SUMMARY OF BACKGROUND DATA: Developmental spinal stenosis is a precipitating factor in patients presenting with lumbar canal stenosis. Yet, due to a lack of agreement on definitions and methods of assessment, as well as ethnic-specific normative values, its prevalence and significance is not known. METHODS: This was a case-control study comparing 100 age and sex-matched asymptomatic, volunteers with that of 100 patients who underwent surgery for spinal stenosis. All patients were of Chinese ethnicity and their details were blinded to 2 observers. Spinal stenosis parameters were measured on the basis of axial (pedicle level) and sagittal (midsagittal) magnetic resonance images. RESULTS: Anteroposterior spinal canal diameters change with levels. At each level, patients were found to have significantly narrower anteroposterior canal diameters than controls. By use of receiver operating characteristic curve, we defined developmental spinal stenosis if the anteroposterior canal diameter was at L1 <20 mm, L2 <19 mm, L3 <19 mm, L4 <17 mm, L5 <16 mm, and at S1 <16 mm on the basis of a value including 50% of controls and demonstrated best sensitivity and specificity. Furthermore, for L4, L5, and S1, critical stenosis values could be defined, below which almost all subjects needed surgery, these were L4 <14 mm, L5 <14 mm, and S1 <12 mm. CONCLUSION: This is the largest magnetic resonance imaging-based study with standardized measurements and comparable groups to determine clinically relevant magnetic resonance imaging criteria for lumbar spinal stenosis. The findings strongly suggest that developmental stenosis plays an important role in the pathogenesis of symptomatic spinal stenosis. Critical values of stenosis below which symptoms were highly likely were defined. These will need to be validated by longitudinal studies in future. However, they may possess clinical utility in determining the appropriate levels requiring canal-widening surgery.Level of Evidence: 3.
Persistent Identifierhttp://hdl.handle.net/10722/203252
ISSN
2015 Impact Factor: 2.439
2015 SCImago Journal Rankings: 1.459
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorCheung, JPYen_US
dc.contributor.authorSamartzis, Den_US
dc.contributor.authorShigematsu, Hen_US
dc.contributor.authorCheung, KMCen_US
dc.date.accessioned2014-09-19T13:11:34Z-
dc.date.available2014-09-19T13:11:34Z-
dc.date.issued2014en_US
dc.identifier.citationSpine, 2014, v. 39 n. 13, p. 1067-1076en_US
dc.identifier.issn0362-2436en_US
dc.identifier.urihttp://hdl.handle.net/10722/203252-
dc.description.abstractSTUDY DESIGN: Case-control study. OBJECTIVE: The aim of this study was to define clinically relevant relative and critical (absolute) magnetic resonance imaging values of lumbar spinal stenosis in a cohort of 100 surgical cases and 100 asymptomatic controls. SUMMARY OF BACKGROUND DATA: Developmental spinal stenosis is a precipitating factor in patients presenting with lumbar canal stenosis. Yet, due to a lack of agreement on definitions and methods of assessment, as well as ethnic-specific normative values, its prevalence and significance is not known. METHODS: This was a case-control study comparing 100 age and sex-matched asymptomatic, volunteers with that of 100 patients who underwent surgery for spinal stenosis. All patients were of Chinese ethnicity and their details were blinded to 2 observers. Spinal stenosis parameters were measured on the basis of axial (pedicle level) and sagittal (midsagittal) magnetic resonance images. RESULTS: Anteroposterior spinal canal diameters change with levels. At each level, patients were found to have significantly narrower anteroposterior canal diameters than controls. By use of receiver operating characteristic curve, we defined developmental spinal stenosis if the anteroposterior canal diameter was at L1 <20 mm, L2 <19 mm, L3 <19 mm, L4 <17 mm, L5 <16 mm, and at S1 <16 mm on the basis of a value including 50% of controls and demonstrated best sensitivity and specificity. Furthermore, for L4, L5, and S1, critical stenosis values could be defined, below which almost all subjects needed surgery, these were L4 <14 mm, L5 <14 mm, and S1 <12 mm. CONCLUSION: This is the largest magnetic resonance imaging-based study with standardized measurements and comparable groups to determine clinically relevant magnetic resonance imaging criteria for lumbar spinal stenosis. The findings strongly suggest that developmental stenosis plays an important role in the pathogenesis of symptomatic spinal stenosis. Critical values of stenosis below which symptoms were highly likely were defined. These will need to be validated by longitudinal studies in future. However, they may possess clinical utility in determining the appropriate levels requiring canal-widening surgery.Level of Evidence: 3.en_US
dc.languageengen_US
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com-
dc.relation.ispartofSpineen_US
dc.rightsThis is a non-final version of an article published in final form in Spine, 2014, v. 39 n. 13, p. 1067-1076-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.titleDefining clinically relevant values for developmental spinal stenosis: a large-scale magnetic resonance imaging studyen_US
dc.typeArticleen_US
dc.identifier.emailCheung, JPY: cheungjp@hku.hken_US
dc.identifier.emailSamartzis, D: dspine@hku.hken_US
dc.identifier.emailCheung, KMC: cheungmc@hku.hken_US
dc.identifier.authorityCheung, JPY=rp01685en_US
dc.identifier.authoritySamartzis, D=rp01430en_US
dc.identifier.authorityCheung, KMC=rp00387en_US
dc.description.naturepostprint-
dc.identifier.doi10.1097/BRS.0000000000000335en_US
dc.identifier.pmid24732859-
dc.identifier.hkuros238012en_US
dc.identifier.hkuros228885-
dc.identifier.volume39en_US
dc.identifier.issue13en_US
dc.identifier.spage1067en_US
dc.identifier.epage1076en_US
dc.identifier.isiWOS:000337476700018-
dc.publisher.placeUnited States-

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