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

BMC Musculoskeletal Disorders

Olavi Airaksinen⁸  Ville Leinonen¹  Veli Turunen⁴  Heikki Kröger⁷  Sakari Savolainen⁹  Sanna Sinikallio²  Timo Juhani Aalto^1,10  Tapani Saari⁶  Petri Sipola⁵  Pekka Kuittinen³ 

[1] Unit of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland;Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland;Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland;Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland;Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland;Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland;Department of Orthopaedics and Traumatology, Kuopio University Hospital and Bone and Cartilage Research Unit, University of Eastern Finland, Kuopio, Finland;Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland;Department of Neurosurgery, Kuopio University Hospital, Puijonlaaksontie 2, PO Box 1777, Kuopio 70210, Finland;Health Center Ikioma OY, Mikkeli, Finland

关键词: Walking distance;    Disability;    Leg pain;    Low back pain;    MRI;    Magnetic resonance imaging;    Spinal stenosis;   

Others  :  1118648
DOI  :  10.1186/1471-2474-15-348

 received in 2013-05-10, accepted in 2014-10-08,  发布年份 2014

【 摘 要 】

Background

Lumbar spinal stenosis (LSS) is the common term used to describe patients with symptoms related to the anatomical reduction of the lumbar spinal canal size. However, some subjects may have a markedly narrowed canal without any symptoms. This raises the question of what is the actual role of central canal stenosis in symptomatic patients. The purpose of this study was to compare radiological evaluations of LSS, both visually and quantitatively, with the clinical findings of patients with LSS.

Methods

Eighty patients [mean age 63 (11) years, 44% male], with symptoms severe enough to indicate LSS surgery, were included in this prospective single-center study. Lumbar magnetic resonance imaging was performed and one experienced neuroradiologist classified patients into three groups: 0 = normal or mild stenosis, 1 = moderate stenosis, and 2 = severe stenosis. In addition, the same observer measured the minimal dural sac area level by level from the inferior aspect of L1 to the inferior aspect of S1. The association between radiological and clinical findings were tested with Oswestry Disability Index, overall visual analog pain scale, specific low back pain, specific leg pain, Beck Depression Inventory, and walking distance on treadmill exercise test.

Results

In the visual classification of the central spinal canal, leg pain was significantly higher and walking distance achieved was shorter among patients with moderate central stenosis than in patients with severe central stenosis (7.33 (2.29) vs 5.80 (2.72); P = 0.008 and 421 (431) m vs 646 (436) m; P = 0.021, respectively). Patients with severe stenosis at only one level also achieved shorter walking distance than patients with severe stenosis of at least two levels. No correlation between visually or quantitatively assessed stenosis and other clinical findings was found.

Conclusions

There is no straightforward association between the stenosis of dural sac and patient symptoms or functional capacity. These findings indicated that dural sac stenosis is not the single key element in the pathophysiology of LSS.

【 授权许可】

   
2014 Kuittinen et al.; licensee BioMed Central Ltd.

【 图 表 】

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