• MIS decompression
• dual-level surgery
• lumbar spinal stenosis
• single-level surgery

• Humans
• Female
• Male
• Middle Aged
• Prospective Studies
• Magnetic Resonance Imaging/methods
• Lumbar Vertebrae/diagnostic imaging
• Surveys and Questionnaires
• Low Back Pain/diagnostic imaging
• Aged
• Adult

• electrodiagnosis
• electromyography
• repeat
• serial

• Adult
• Humans
• Electrodiagnosis/methods
• Electromyography/methods
• Nervous System Diseases/diagnosis
• Nervous System Diseases/physiopathology
• Neural Conduction/physiology
• Neuromuscular Diseases/diagnosis
• Neuromuscular Diseases/physiopathology

• Adjacent level stenosis
• Decompression
• Lumbar spinal stenosis
• Multilevel spinal stenosis
• Surgical treatment

• Humans
• Spinal Stenosis/surgery
• Decompression, Surgical/methods
• Lumbar Vertebrae/surgery
• Male
• Female
• Aged
• Prospective Studies
• Middle Aged
• Treatment Outcome

• clinical features
• lateral spinal stenosis
• magnetic resonance imaging (mri)
• oswestry disability index
• visual analogue score

• lumbar spinal stenosis
• neurosurgery
• spinal cord injury
• surgical tool entrapment

• Shahid Beheshti University of Medical Sciences

• Correlation
• Diagnosis
• Low back pain
• MRI
• Pain management

• Humans
• Low Back Pain/diagnosis
• Magnetic Resonance Imaging/methods
• Diagnostic Errors
• Lumbar Vertebrae/diagnostic imaging
• Lumbosacral Region

• Central stenosis
• Lumbar decompression
• Patient-reported outcomes

• Caudal epidural steroid
• Lumbar spinal stenosis
• Ozone therapy
• Ultrasound Guidance

• Balance
• Dual task
• Gait
• Older adult patient
• Single task
• Spinal stenosis

• Health information sharing
• Physical and psychosocial wellbeing
• Spinal stenosis
• Twitter

• Electrodiagnosis
• Evoked potentials
• Magnetic resonance imaging
• Spinal stenosis

• Clinical outcome
• Degenerative lumbar disease
• Nerve root edema
• Retrospective study
• Sciatica

Patient-reported outcome measures (PROMs) are commonly used to estimate disability of patients with spinal degenerative disease. Emerging technological advances present an opportunity to provide objective measurements of activity. In a prospective, observational study we utilized a low-cost consumer grade wearable accelerometer (LCA) to determine patient activity (steps per day) preoperatively (baseline) and up to one year (Y1) after cervical and lumbar spine surgery. We studied 30 patients (46.7% male; mean age 57 years; 70% Caucasian) with a baseline activity level of 5624 steps per day. The activity level decreased by 71% in the 1^st postoperative week (p < 0.001) and remained 37% lower in the 2^nd (p < 0.001) and 23% lower in the 4^th week (p = 0.015). At no time point until Y1 did patients increase their activity level, compared to baseline. Activity was greater in patients with cervical, as compared to patients with lumbar spine disease. Age, sex, ethnic group, anesthesia risk score and fusion were variables associated with activity. There was no correlation between activity and PROMs, but a strong correlation with depression. Determining activity using LCAs provides real-time and longitudinal information about patient mobility and return of function. Recovery took place over the first eight postoperative weeks, with subtle improvement afterwards.

• Diffusion tensor imaging
• Motor Function
• Pain
• Stenosis
• Surgery
• Symptoms

• Restless leg syndrome
• spinal canal
• spinal stenosis

• Aged
• Aging
• Cross-Sectional Studies
• Female
• Humans
• Lumbosacral Region/pathology
• Male
• Middle Aged
• Reference Values
• Restless Legs Syndrome/diagnosis
• Restless Legs Syndrome/pathology
• Sex Characteristics
• Spinal Stenosis/diagnosis
• Spinal Stenosis/pathology

• Disability
• Functional test
• Objective functional impairment
• Objective outcome measure
• Physical function
• Systematic review

• Intermittent claudication
• Lumbar spinal stenosis
• Non-operative treatment
• Randomized controlled trial
• Transcutaneous electrical nerve stimulation (TENS)
• Walking

Age-related degenerative changes in the lumbar spine frequently result in nerve root compression causing severe pain and disability. Given the increasing incidence of lumbar spinal disorders in the aging population and the discrepancies between the use of current diagnostic imaging tools and clinical symptoms, novel methods of nerve root assessment are needed. We investigated elderly patients with stenosis at L4-L5 or L5-S1 levels. Diffusion tensor imaging (DTI) was used to quantify microstructure in compressed L5 nerve roots and investigate relationships to clinical symptoms and motor neurophysiology. DTI metrics (i.e. FA, MD, AD and RD) were measured at proximal, mid and distal segments along compressed (i.e. L5) and intact (i.e. L4 or S1) nerve roots. FA was significantly reduced in compressed nerve roots and MD, AD and RD were significantly elevated in the most proximal segment of the nerve root studied. FA was significantly correlated with electrophysiological measures of root function: minimum F-wave latency and peripheral motor conduction time (PMCT). In addition, FA along the compressed root also correlated with leg pain and depression score. There was also a relationship between RD and anxiety, leg pain and disability score and AD correlated with depression score. Taken together, these data show that DTI metrics are sensitive to nerve root compression in patients with stenosis as a result of age-related lumbar degeneration. Critically, they show that the changes in microstructural integrity along compressed L5 nerve roots are closely related to a number of clinical symptoms associated with the development of chronic pain as well as neurophysiological assessments of motor function. These inherent relationships between nerve root damage and phenotype suggest that the use DTI is a promising method as a way to stratify treatment selection and predict outcomes.

•

DTI can be used to quantify lumbar spinal nerve root compression in elderly patients.

• Age
• DTI
• Entrapment
• Neuropathic pain
• Neurophysiology
• Spinal nerve

The North American Spine Society states that lumbar spinal stenosis (LSS) is a clinical syndrome, and there is insufficient evidence to make a recommendation for or against a correlation between clinical symptoms or function and the presence of anatomic narrowing of the spinal canal on MRI. The main purpose of this study was to assess the influence of the magnitude of dural tube compression on MRI on LSS symptoms at the cross-sectional and 1-year follow-up.

This was a prospective cohort study of 459 participants who were assessed for LSS using a questionnaire and conventional MRI of the lumbar spine. After 1 year, 335 subjects (follow-up rate 73.0%) were assessed for LSS using the same questionnaire. The time course of the clinical subjective symptoms of LSS and the relationship between the said symptoms of LSS and magnitude of dural tube compression on MRI were analyzed in a cross-sectional and longitudinal fashion.

1) The dural sac cross-sectional area (DCSA) decreased with age. 2) Severe dural tube compression had a strong influence on the presence of symptomatic LSS; however, 40%–70% of participants with severe dural tube compression did not show clinical symptoms of LSS. 3) At the 1-year follow-up, >50% of the LSS-positive participants in the initial year were reclassified as LSS negative, and 10% of the LSS-negative participants were reclassified as LSS positive. 4) The magnitude of the DCSA on MRI did not directly affect the presence of LSS at the 1-year follow-up.

LSS symptoms were changeable. Anatomical dural tube compression on MRI did not predict the presence of clinical LSS symptoms at the 1-year follow-up.

• MRI
• comorbidities
• cross-sectional area
• epidemiology
• lumbar spinal stenosis
• natural history
• prognostic factors
• quality of life

Introduction

Lumbar spinal stenosis (LSS) is a kinetic-dependent disease typically aggravating during spinal loading. To date, assessment of LSS is usually performed with magnetic resonance imaging (MRI). However, conventional supine MRI is associated with significant drawbacks as it does not truly reflect physiological loads, experienced by discoligamentous structures during erect posture. Consequently, supine MRI often fails to reveal the source of pain and/or disability caused by LSS.

The present study sought to assess neural dimensions via MRI in supine, upright, and upright-hyperlordotic position in order to evaluate the impact of patient positioning on neural narrowing. Therefore, radiological measures such as neuroforaminal dimensions, central canal volume, sagittal listhesis, and lumbar lordosis at spinal level L4/5 were extracted and stratified according to patient posture.

Materials and methods

Overall, 10 subjects were enclosed in this experimental study. MRI was performed in three different positions: (1) 0° supine (SP), (2) 80° upright (UP), and (3) 80° upright + hyperlordotic (HY) posture. Upright MRI was conducted utilizing a 0.25T open-configuration scanner equipped with a rotatable examination bed allowing for true standing MRI. Radiographic outcome of upright MRI imaging was extracted and evaluated according to patient positioning.

Results

Upright MRI-based assessment of neural dimensions was successfully accomplished in all subjects. Overall, radiographic parameters revealed a significant decrease of neural dimensions from supine to upright position: Specifically, mean foraminal area decreased from SP to UP by 13.3% (P ≤ 0.05) as well as from SP to HY position by 21% (P ≤ 0.05). Supplementation of hyperlordosis did not result in additional narrowing of neural elements (P ≥ 0.05). Furthermore, central canal volume revealed a decrease of 7% at HY and 8% at UP compared to SP position (P ≥ 0.05). Assessment of lumbar lordosis yielded in a significant increase when assessed at HY (+22.1%) or UP (+8.7%) compared to SP (P ≤ 0.05).

Conclusions

Our data suggest that neuroforaminal dimensions assessed by conventional supine MRI are potentially overestimated in patients with LSS. Especially, in patients having occult disease not visualized on conventional imaging modalities, upright MRI allows for a precise, clinically relevant, and at the same time non-invasive evaluation of neural elements in LSS when neural decompression is considered.

• decompression
• degeneration
• lumbar
• mri
• neural stenosis
• spine
• surgery
• upright mri

• inter-observer reliability
• intra-observer reliability
• lumbar spinal stenosis
• radiological grading
• surgeon experience

• dural sac cross-sectional area
• lumbar central canal spinal stenosis
• spinal canal cross-sectional area

• Aged
• Aged, 80 and over
• Case-Control Studies
• Dura Mater/diagnostic imaging
• Dura Mater/pathology
• Female
• Humans
• Lumbar Vertebrae/diagnostic imaging
• Lumbar Vertebrae/pathology
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Pain Management
• Retrospective Studies
• Spinal Stenosis/diagnostic imaging
• Spinal Stenosis/pathology

• Africa
• Computed tomography
• Lumbar spinal stenosis
• Symptoms

Correlation 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.

MRIs 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.

48 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).

This 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.

To determine whether the effectiveness of core stability exercises correlates with the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis.

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.

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).

There was no significantcorrelation between the effectiveness of core stability exercises and the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis.

• Core stability exercises (CSE)
• Japanese Orthopaedic Association score (JOA)
• Lumbar spinal stenosis (LSS)
• Self-reported walking distance

• Comparison
• Japanese Orthopedic Association Back Pain Evaluation Questionnaire
• Lumbar canal stenosis
• MRI morphology stenosis grades

To assess the correlation of lateral recess stenosis (LRS) of lumbar segments L4/5 and L5/S1 and the Oswestry Disability Index (ODI).

Nine hundred and twenty-seven patients with history of low back pain were included in this uncontrolled study. On magnetic resonance images (MRI) the lateral recesses (LR) at lumbar levels L4/5 and L5/S1 were evaluated and each nerve root was classified into a 4-point grading scale (Grade 0-3) as normal, not deviated, deviated or compressed. Patient symptoms and disability were assessed using ODI. The Spearman’s rank correlation coefficient was used for statistical analysis (P < 0.05).

Approximately half of the LR revealed stenosis (grade 1-3; 52% at level L4/5 and 42% at level L5/S1) with 2.2% and 1.9% respectively reveal a nerve root compression. The ODI score ranged from 0%-91.11% with an arithmetic mean of 34.06% ± 16.89%. We observed a very weak statistically significant positive correlation between ODI and LRS at lumbar levels L4/5 and L5/S1, each bilaterally (L4/5 left: rho < 0.105, P < 0.01; L4/5 right: rho < 0.111, P < 0.01; L5/S1 left: rho 0.128, P < 0.01; L5/S1 right: rho < 0.157, P < 0.001).

Although MRI is the standard imaging tool for diagnosing lumbar spinal stenosis, this study showed only a weak correlation of LRS on MRI and clinical findings. This can be attributed to a number of reasons outlined in this study, underlining that imaging findings alone are not sufficient to establish a reliable diagnosis for patients with LRS.

• Low back pain
• Lumbar spine
• Magnetic resonance imaging
• Lateral recess stenosis
• Oswestry Disability Score
• Lumbar spinal canal stenosis

• Dural sac cross-sectional area
• Imaging
• Low back pain
• Lumbar spinal stenosis
• Magnetic resonance imaging

• Adult
• Female
• Humans
• Imaging, Three-Dimensional/methods
• Lordosis/diagnostic imaging
• Magnetic Resonance Imaging/methods
• Male
• Middle Aged
• Spinal Canal/diagnostic imaging
• Spinal Stenosis/diagnostic imaging

• MFE 113023 CIHR

• Demography
• Female
• Humans
• Lumbar Vertebrae/pathology
• Lumbar Vertebrae/surgery
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Spinal Stenosis/surgery
• Surveys and Questionnaires
• Treatment Outcome

• Analgesics/therapeutic use
• Anti-Inflammatory Agents/therapeutic use
• Decision Support Techniques
• Decompression, Surgical
• Diagnostic Imaging/methods
• Humans
• Incidence
• Injections, Epidural
• Intermittent Claudication/etiology
• Lumbar Vertebrae
• Musculoskeletal Pain/etiology
• Physical Therapy Modalities
• Postoperative Care
• Prevalence
• Scoliosis/complications
• Spinal Fusion/methods
• Spinal Stenosis/diagnosis
• Spinal Stenosis/epidemiology
• Spinal Stenosis/therapy
• Spondylolisthesis/complications
• Steroids/administration & dosage
• United States/epidemiology

• P60-AR048094 NIAMS NIH HHS
• P60-AR062799 NIAMS NIH HHS

• Beck depression inventory
• Dural sac cross sectional area
• MRI findings
• Oswestry disability index
• Pittsburgh sleep quality index
• Spinal stenosis

• Humans
• Lumbar Vertebrae/anatomy & histology
• Lumbar Vertebrae/pathology
• Magnetic Resonance Imaging
• Spinal Canal/anatomy & histology
• Spinal Canal/pathology
• Spinal Stenosis/diagnosis
• Spinal Stenosis/pathology

• Female
• Humans
• Lumbar Vertebrae/surgery
• Magnetic Resonance Imaging
• Male
• Quality of Life
• Spinal Fusion
• Spinal Stenosis/classification
• Spinal Stenosis/diagnosis
• Spinal Stenosis/etiology
• Spinal Stenosis/surgery
• Treatment Outcome