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Yang J, Xiong Y, Hu Y, Huang M, Zhang L, Pu X, Li Q. The reliability, correlation with clinical symptoms and surgical outcomes of dural sac cross-sectional area, nerve root sedimentation sign and morphological grade for lumbar spinal stenosis. BMC Musculoskelet Disord 2023; 24:225. [PMID: 36964515 PMCID: PMC10039594 DOI: 10.1186/s12891-023-06353-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/21/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND No study had directly compared the reliability, correlation with clinical symptoms, and surgical outcomes of dural sac cross-sectional area (DCSA), nerve root sedimentation sign (SedSign), and morphological grade for lumbar spinal stenosis (LSS). METHODS From January 2017 to December 2020, 202 patients with LSS were retrospectively analyzed. The narrowest segments were assessed via T2-weighted cross-sectional images using DCSA, morphological grade, and SedSign by two independent observers. Three classifications' reliabilities were evaluated. Correlations between three classifications and between each of the classifications and symptoms or surgical outcomes 12 months postoperatively were evaluated. RESULTS There were 144 males and 58 females; 23, 52, and 127 patients had the narrowest segment in L2-3, L3-4, and L4-5, respectively. The intra-observer reliability of DCSA ranged from 0.91 to 0.93, and the inter-observer reliability was 0.90. The intra-observer reliability of SedSign ranged from 0.83 to 0.85, and the inter-observer reliability was 0.75. The intra-observer reliability of morphological grade ranged from 0.72 to 0.78, and the inter-observer reliability was 0.61. Each of these classifications was correlated with the other two (P < 0.01). For preoperative symptoms, DCSA was correlated with leg pain (LP) (r = - 0.14), Oswestry Disability Index (ODI) (r = - 0.17), and claudication (r = - 0.19). Morphological grade was correlated with LP (r = 0.19) and claudication (r = 0.27). SedSign was correlated with ODI (r = 0.23). For postoperative outcomes, morphological grade was correlated with LP (r = - 0.14), and SedSign was correlated with ODI (r = 0.17). CONCLUSIONS Substantial to almost perfect intra and inter-observer reliabilities for the three classifications were found; however, these classifications had either weak correlations with symptoms and surgical outcomes or none at all. Based on our findings, using one of them without conducting other tests for LSS will have limited or uncertain value in surgical decision-making or evaluating the prognostic value.
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Affiliation(s)
- Jin Yang
- Department of Orthopedic Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, Sichuan, 646000, China
| | - Yiling Xiong
- Department of Radiology, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, Sichuan, 646000, China
| | - Yuexuan Hu
- Department of Clinical Skills Center, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, Sichuan, 646000, China
| | - Mei Huang
- Department of Clinical Skills Center, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, Sichuan, 646000, China
| | - Li Zhang
- Department of Clinical Skills Center, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, Sichuan, 646000, China
| | - Xia Pu
- Department of Clinical Skills Center, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, Sichuan, 646000, China
| | - Qiuhan Li
- Department of Clinical Skills Center, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, Sichuan, 646000, China.
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Seo J, Lee JW. Magnetic Resonance Imaging Grading Systems for Central Canal and Neural Foraminal Stenoses of the Lumbar and Cervical Spines With a Focus on the Lee Grading System. Korean J Radiol 2023; 24:224-234. [PMID: 36788771 PMCID: PMC9971835 DOI: 10.3348/kjr.2022.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 02/16/2023] Open
Abstract
Magnetic resonance imaging (MRI) is a standard imaging modality for diagnosing spinal stenosis, which is a common degenerative disorder in the elderly population. Standardized interpretation of spinal MRI for diagnosing and grading the severity of spinal stenosis is necessary to ensure correct communication with clinicians and to conduct clinical research. In this review, we revisit the Lee grading system for central canal and neural foraminal stenosis of the cervical and lumbar spine, which are based on the pathophysiology and radiologic findings of spinal stenosis.
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Affiliation(s)
- Jiwoon Seo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
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3
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Getzmann JM, Ashouri H, Burgstaller JM, Valeri F, Winklhofer S, Ulrich NH, Guggenberger R. The Effect of Paraspinal Fatty Muscle Infiltration and Cumulative Lumbar Spine Degeneration on the Outcome of Patients With Lumbar Spinal Canal Stenosis: Analysis of the Lumbar Stenosis Outcome Study (LSOS) Data. Spine (Phila Pa 1976) 2023; 48:97-106. [PMID: 36130038 PMCID: PMC9750091 DOI: 10.1097/brs.0000000000004477] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective. OBJECTIVE To investigate the influence of paraspinal fatty muscle infiltration (FMI) and cumulative lumbar spine degeneration as assessed by magnetic resonance imaging on long-term clinical outcome measures in patients with lumbar spinal canal stenosis (LSCS) of the Lumbar Stenosis Outcome Study (LSOS) cohort. SUMMARY OF BACKGROUND DATA Past studies have tried to establish correlations of morphologic imaging findings in LSCS with clinical endpoints. However, the impact of FMI and overall lumbar spinal degeneration load has not been examined yet. MATERIALS AND METHODS Patients from the LSOS cohort with moderate to severe LSCS were included. Two radiologists assessed the degree of LSCS as well as cumulative degeneration of the lumbar spine. FMI was graded using the Goutallier scoring system. Spinal Stenosis Measure (SSM) was used to measure the severity level of symptoms and disability. European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) was used to measure health-related quality of life. RESULTS The nonsurgically treated group consisted of 116 patients (age 74.8±8.5 yr), whereas the surgically treated group included 300 patients (age 72.3±8.2 yr). Paraspinal FMI was significantly different between the groups (54.3% vs. 32.0% for Goutallier grade ≥2; P <0.001). Total degeneration score was comparable in both groups (9.5±2.0 vs. 9.3±2.0; P =0.418). FMI was associated with lower SSM function and lower EQ-5D-3L (all P <0.05), but not with SSM symptoms. Total degeneration of the lumbar spine was associated neither with SSM symptoms, nor with SSM function, nor with EQ-5D-3L (all P >0.05). CONCLUSIONS FMI is associated with higher disability and worse health-related quality of life of LSCS patients in the LSOS cohort. There was no significant association between total cumulative lumbar spine degeneration and the outcome of either surgically or nonsurgically treated patients. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Jonas M. Getzmann
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich (USZ), Zurich, Switzerland
- University of Zurich (UZH), Zurich, Switzerland
| | - Hamidreza Ashouri
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich (USZ), Zurich, Switzerland
- University of Zurich (UZH), Zurich, Switzerland
| | - Jakob M. Burgstaller
- University of Zurich (UZH), Zurich, Switzerland
- Institute of Primary Care, University Hospital Zurich (USZ), Zurich, Switzerland
| | - Fabio Valeri
- University of Zurich (UZH), Zurich, Switzerland
- Institute of Primary Care, University Hospital Zurich (USZ), Zurich, Switzerland
| | - Sebastian Winklhofer
- University of Zurich (UZH), Zurich, Switzerland
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich (USZ), Zurich, Switzerland
| | - Nils H. Ulrich
- University of Zurich (UZH), Zurich, Switzerland
- University Spine Center Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - Roman Guggenberger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich (USZ), Zurich, Switzerland
- University of Zurich (UZH), Zurich, Switzerland
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4
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Elfadle AA, Zarad CA, Elmaaty AAA, El-Nagaa BFA, Soliman AY. Correlation between lumbar spinal canal magnetic resonance imaging grading systems and parameters in lumbar spinal canal compromise. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There is a need to assess how commonly used classification systems of intervertebral disc degeneration reflect the compromise of neural elements. This study aims to explore the relationship between lumbar discs degenerative diseases using the Pfirrmann and the Combined Task Forces (CTF) of the North American Spine Society (NASS) grading systems as well as qualitative and quantitative grades of lumbar spinal stenosis. This retrospective cohort study included adult patients undergoing non-contrast MR imaging of lumbosacral spine. The radiological assessment included the Pfirrmann grading system, Van Rijn classification, Combined Task Force (CTF) classification, measurement of the cross-sectional area of the dural sac, mid-sagittal antero-posterior diameter of the thecal sac, the degree of dural sac compression at disc level, lateral recesses heights, and intervertebral foramina diameters. The degree of stenosis of the spinal canal and intervertebral foramina was assessed.
Results
One hundred patients were included in the study. At all levels, Pfirrmann grades had a moderate, significant, positive correlation with the severity of stenosis of the central and lateral spinal canals as well as foraminal stenosis. The grades of lumbar spinal canal and foraminal stenosis had a significant positive correlation with degree of disc displacement as assessed by CTF classification and had a significant negative correlation with the quantitative lumbar spinal canal and foraminal measures.
Conclusions
There is a good correlation between Pfirrmann classification, CTF classification of NASS, qualitative grading and quantitative measures of lumbar spinal canal that reflects the severity of lumbar spinal canal stenosis and nerve root compression.
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Ruiz Santiago F, Láinez Ramos-Bossini AJ, Wáng YXJ, Martínez Barbero JP, García Espinosa J, Martínez Martínez A. The value of magnetic resonance imaging and computed tomography in the study of spinal disorders. Quant Imaging Med Surg 2022; 12:3947-3986. [PMID: 35782254 PMCID: PMC9246762 DOI: 10.21037/qims-2022-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/13/2022] [Indexed: 08/15/2023]
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders.
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Affiliation(s)
| | | | - Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - José Pablo Martínez Barbero
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Jade García Espinosa
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Alberto Martínez Martínez
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
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Ahn DY, Park HJ, Yi JW, Kim JN. To Assess Whether Lee’s Grading System for Central Lumbar Spinal Stenosis Can Be Used as a Decision-Making Tool for Surgical Treatment. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:102-111. [PMID: 36237366 PMCID: PMC9238196 DOI: 10.3348/jksr.2021.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/17/2021] [Accepted: 06/09/2021] [Indexed: 11/15/2022]
Abstract
Purpose To evaluate the correlation between Lee’s grades and surgical intervention for central lumbar spinal stenosis (CLSS) and to assess whether this grading system can be used as a decision-making tool for the surgical treatment of this condition. Materials and Methods This retrospective study included 290 patients (M:F = 156:134; mean age, 46 ± 16 years). Radiologists assessed the presence and grade of CLSS at the stenosis point according to Lee’s grading system, in which CLSS is classified into four grades according to the shape of the cauda equina. Correlation coefficients (rs) between Lee’s grades and the operation were calculated with Spearman rank correlation. Results Among the operated patients, grade 2 was the most commonly assigned grade (50%–58%), grade 3 was less common (35%), and grade 0 was the least common (2%–3%). Among the non-operated patients, grade 1 was the most common (63%–65%), grade 0 was less common (15%–16%), and grade 3 was the least common (8%). The distribution of grades differed between the operated and non-operated groups (p < 0.001). Less than 25% of patients who underwent surgery were assigned grades 0 and 1, and more than 88% were assigned grades 2 and 3. A moderate correlation was found between the grade and surgical intervention (rs = 0.632 and rs = 0.583). Conclusion Lee’s grade was moderately correlated with surgical intervention. Lee’s grading system can be a decision-making tool for the surgical treatment of CLSS.
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Affiliation(s)
- Do Yeon Ahn
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Woo Yi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Na Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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7
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Su ZH, Liu J, Yang MS, Chen ZY, You K, Shen J, Huang CJ, Zhao QH, Liu EQ, Zhao L, Feng QJ, Pang SM, Li SL, Lu H. Automatic Grading of Disc Herniation, Central Canal Stenosis and Nerve Roots Compression in Lumbar Magnetic Resonance Image Diagnosis. Front Endocrinol (Lausanne) 2022; 13:890371. [PMID: 35733770 PMCID: PMC9207332 DOI: 10.3389/fendo.2022.890371] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
AIM Accurate severity grading of lumbar spine disease by magnetic resonance images (MRIs) plays an important role in selecting appropriate treatment for the disease. However, interpreting these complex MRIs is a repetitive and time-consuming workload for clinicians, especially radiologists. Here, we aim to develop a multi-task classification model based on artificial intelligence for automated grading of lumbar disc herniation (LDH), lumbar central canal stenosis (LCCS) and lumbar nerve roots compression (LNRC) at lumbar axial MRIs. METHODS Total 15254 lumbar axial T2W MRIs as the internal dataset obtained from the Fifth Affiliated Hospital of Sun Yat-sen University from January 2015 to May 2019 and 1273 axial T2W MRIs as the external test dataset obtained from the Third Affiliated Hospital of Southern Medical University from June 2016 to December 2017 were analyzed in this retrospective study. Two clinicians annotated and graded all MRIs using the three international classification systems. In agreement, these results served as the reference standard; In disagreement, outcomes were adjudicated by an expert surgeon to establish the reference standard. The internal dataset was randomly split into an internal training set (70%), validation set (15%) and test set (15%). The multi-task classification model based on ResNet-50 consists of a backbone network for feature extraction and three fully-connected (FC) networks for classification and performs the classification tasks of LDH, LCCS, and LNRC at lumbar MRIs. Precision, accuracy, sensitivity, specificity, F1 scores, confusion matrices, receiver-operating characteristics and interrater agreement (Gwet k) were utilized to assess the model's performance on the internal test dataset and external test datasets. RESULTS A total of 1115 patients, including 1015 patients from the internal dataset and 100 patients from the external test dataset [mean age, 49 years ± 15 (standard deviation); 543 women], were evaluated in this study. The overall accuracies of grading for LDH, LCCS and LNRC were 84.17% (74.16%), 86.99% (79.65%) and 81.21% (74.16%) respectively on the internal (external) test dataset. Internal and external testing of three spinal diseases showed substantial to the almost perfect agreement (k, 0.67 - 0.85) for the multi-task classification model. CONCLUSION The multi-task classification model has achieved promising performance in the automated grading of LDH, LCCS and LNRC at lumbar axial T2W MRIs.
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Affiliation(s)
- Zhi-Hai Su
- Department of Spinal Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Jin Liu
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Min-Sheng Yang
- Department of Spinal Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Zi-Yang Chen
- Department of Spinal Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Ke You
- Department of Spinal Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Jun Shen
- Department of Spinal Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Cheng-Jie Huang
- Department of Spinal Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Qing-Hao Zhao
- Department of Spinal Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - En-Qing Liu
- Department of Spinal Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Lei Zhao
- School of Biomedical Engineering, Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Qian-Jin Feng
- School of Biomedical Engineering, Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Shu-Mao Pang
- School of Biomedical Engineering, Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Shao-Lin Li
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
- *Correspondence: Hai Lu, ; Shao-Lin Li,
| | - Hai Lu
- Department of Spinal Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
- *Correspondence: Hai Lu, ; Shao-Lin Li,
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8
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Imaging of the Ageing Spine. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Miskin N, Isaac Z, Lu Y, Makhni MC, Sarno DL, Smith TR, Zampini JM, Mandell JC. Simplified Universal Grading of Lumbar Spine MRI Degenerative Findings: Inter-Reader Agreement of Non-Radiologist Spine Experts. PAIN MEDICINE 2021; 22:1485-1495. [PMID: 33713135 DOI: 10.1093/pm/pnab098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/23/2021] [Accepted: 03/09/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE 1) To describe a simplified multidisciplinary grading system for the most clinically relevant lumbar spine degenerative changes. 2) To measure the inter-reader variability among non-radiologist spine experts in their use of the classification system for interpretation of a consecutive series of lumbar spine magnetic resonance imaging (MRI) examinations. METHODS ATS multidisciplinary and collaborative standardized grading of spinal stenosis, foraminal stenosis, lateral recess stenosis, and facet arthropathy was developed. Our institution's picture archiving and communication system was searched for 50 consecutive patients who underwent non-contrast MRI of the lumbar spine for chronic back pain, radiculopathy, or symptoms of spinal stenosis. Three fellowship-trained spine subspecialists from neurosurgery, orthopedic surgery, and physiatry interpreted the 50 exams using the classification at the L4-L5 and L5-S1 levels. Inter-reader agreement was assessed with Cohen's kappa coefficient. RESULTS For spinal stenosis, the readers demonstrated substantial agreement (κ = 0.702). For foraminal stenosis and facet arthropathy, the three readers demonstrated moderate agreement (κ = 0.544, and 0.557, respectively). For lateral recess stenosis, there was fair agreement (κ = 0.323). CONCLUSIONS A simplified universal grading system of lumbar spine MRI degenerative findings is newly described. Use of this multidisciplinary grading system in the assessment of clinically relevant degenerative changes revealed moderate to substantial agreement among non-radiologist spine physicians. This standardized grading system could serve as a foundation for interdisciplinary communication.
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Affiliation(s)
- Nityanand Miskin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zacharia Isaac
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi Lu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melvin C Makhni
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Danielle L Sarno
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jay M Zampini
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Pizzini FB, Poletti M, Beltramello A, Muto M, Splendiani A, Mehrabi S, Costanzo G, Vitiello V, Barile A, Colagrande S, Mansueto G, Bastianello S. Degenerative spine disease: Italian position paper on acquisition, interpretation and reporting of Magnetic Resonance Imaging. Insights Imaging 2021; 12:14. [PMID: 33575851 PMCID: PMC7878635 DOI: 10.1186/s13244-020-00952-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To promote a better radiological interpretation of spine degeneration, a consistent standardization of the acquisition, interpretation and description of Magnetic Resonance Imaging (MRI) l findings. MATERIALS AND METHODS In order to achieve this objective, a consensus among experts in imaging of degenerative spine disease (DSD) from Italian radiological societies (SIRM-Italian Society of Radiology, AINR-Italian Association of Neuroradiology) was achieved. The representatives of the Italian inter-societal working group examined the literature produced by European/American task forces on optimizing the study sequences, classification of degenerative disc changes, spondylo-arthrosis, osteochondrosis, synovial and ligament pathologies of the spinal column, and on canal and foraminal stenosis. The document-resulted from the consensus between experts-was then presented to the scientific societies of Neurosurgery (SINCH) and Orthopedics and Traumatology (SIOT) for their approval. RESULTS This position paper presents a proposal for an optimized MRI protocol for studying DSD and provides a glossary of terms related to this pathology and indications on their use. The international terminological recommendations have been translated and adapted to the Italian language and clinical practice and clinical cases have been used to illustrate some of the main classifications. CONCLUSIONS This revision of international DSD guidelines/recommendations and consensus made it possible to (1) update the nomenclature to international standards and (2) harmonize the MRI protocol and description of radiological findings, adapting both (1, 2) to the Italian context. With this position paper we intend to contribute to an improvement of the communication among doctors and between physicians and their patients as well as the quality of the radiological reports.
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Affiliation(s)
- Francesca B Pizzini
- Department of Diagnostic and Public Health, University of Verona, Piazzale L.A. Scuro, 10, 37100, Verona, Italy.
| | - Mattia Poletti
- Department of Diagnostic and Public Health, University of Verona, Piazzale L.A. Scuro, 10, 37100, Verona, Italy
| | - Alberto Beltramello
- Department of Radiology, IRCCS "Sacro Cuore-Don Calabria", Negrar, Verona, Italy
| | - Mario Muto
- Diagnostic and Interventional Neuroradiology, Cardarelli Hospital, Naples, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Sara Mehrabi
- Department of Diagnostic and Public Health, University of Verona, Piazzale L.A. Scuro, 10, 37100, Verona, Italy
| | | | | | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giancarlo Mansueto
- Department of Diagnostic and Public Health, University of Verona, Piazzale L.A. Scuro, 10, 37100, Verona, Italy
| | - Stefano Bastianello
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Hofmann UK, Keller RL, von Bernstorff M, Walter C, Mittag F. Predictability of the effects of epidural injection in lumbar spinal stenosis by assessment of lumbar MRI scans. J Back Musculoskelet Rehabil 2020; 33:613-621. [PMID: 31743983 DOI: 10.3233/bmr-181249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Numerous classification systems have been proposed to interpret lumbar MRI scans. The clinical impact of the measured parameters remains unclear. To evaluate the clinical significance of imaging results in patients with multisegmental degenerative pathologies, treating specialists can perform image-guided local injections to target defined areas such as the epidural space. OBJECTIVE The aim of this retrospective study was to evaluate the correlation between lumbar spinal stenosis measurements obtained by MRI and improvement obtained through local epidural injection. METHODS In this retrospective study various measurement and classification systems for lumbar spinal stenosis were applied to MRI scans of 100 patients with this pathological condition. The reported effect of epidural bupivacaine/triamcinolone injections at the site was recorded in these patients and a comparative analysis performed. RESULTS MRI features assessed in this study did not show any relevant correlation with reported pain relief after epidural injection in patients with chronic lumbar stenosis, with the exception of posterior disc height with a weak Kendall's tau of -0.187 (p= 0.009). CONCLUSIONS Although MRI is crucial for evaluating lumbar spinal stenosis, it cannot replace but is rather complementary to a good patient history and clinical examination or the results of local diagnostic injections.
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Affiliation(s)
- Ulf Krister Hofmann
- Department of Orthopaedic Surgery, University Hospital of Tübingen, D-72076 Tübingen, Germany
| | - Ramona Luise Keller
- Department of Orthopaedic Surgery, University Hospital of Tübingen, D-72076 Tübingen, Germany.,Faculty of Medicine, Julius-Maximilians University of Würzburg, D-97080 Würzburg, Germany
| | - Maximilian von Bernstorff
- Department of Orthopaedic Surgery, University Hospital of Tübingen, D-72076 Tübingen, Germany.,Faculty of Medicine, Eberhard-Karls University of Tübingen, D-72076 Tübingen, Germany
| | - Christian Walter
- Department of Orthopaedic Surgery, University Hospital of Tübingen, D-72076 Tübingen, Germany
| | - Falk Mittag
- Department of Orthopaedic Surgery, University Hospital of Tübingen, D-72076 Tübingen, Germany
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12
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Ko YJ, Lee E, Lee JW, Park CY, Cho J, Kang Y, Ahn JM. Clinical validity of two different grading systems for lumbar central canal stenosis: Schizas and Lee classification systems. PLoS One 2020; 15:e0233633. [PMID: 32459814 PMCID: PMC7252624 DOI: 10.1371/journal.pone.0233633] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/08/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To assess the learnability of two magnetic resonance imaging (MRI) grading systems for lumbar central canal stenosis based on inter-observer agreement and test-retest reliability of doctors with no prior knowledge of the two systems. MATERIALS AND METHODS Two clinical fellows, one novice radiology resident, one neurosurgeon, and one orthopedic surgeon, who were unaware of the two qualitative MRI grading systems prior to this study, acquainted themselves with the teaching files. All five observers independently assessed the LCCS grade of 70 patients using T2-weighted axial magnetic resonance images at the L2-3, L3-4, L3-4, and L5-S1 disc levels. Analysis was performed twice at an interval of two months. RESULTS The inter-observer agreement among all five readers was excellent and test-retest reliability was moderate to excellent for both the Schizas and Lee systems. Positive percentage agreements were found to be over 0.8 in almost all observers with relatively narrow 95% confidence limits. CONCLUSION Both Schizas and Lee MRI grading systems for LCCS are reliable grading systems, and can be used as a learnable method for both clinicians and radiologists.
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Affiliation(s)
- Yeon-jee Ko
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eugene Lee
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| | - Joon Woo Lee
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chi Young Park
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jungheum Cho
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yusuhn Kang
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joong Mo Ahn
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Sun Z, Li W, Guo Y, Zhou S, Xu F, Chen Z, Qi Q, Guo Z, Zeng Y, Sun C. [Effect of pre-existing adjacent segment degeneration on short-term effectiveness after lumbar fusion surgery]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:837-844. [PMID: 31298000 DOI: 10.7507/1002-1892.201903114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To analyze the prospective effect of pre-existing spinal stenosis of adjacent segment on the short-term effectiveness after lumbar fusion surgery. Methods A prospective comparative study was conducted to divide 183 patients with L 4-S 1 lumbar spinal stenosis who met the selection criteria between July 2015 and December 2017 into two groups according to the status of adjacent segment degeneration (ASD) judged by preoperative disc degeneration and spinal stenosis. There were 98 patients in group A (no degeneration of adjacent segments before operation) and 85 patients in group B (adjacent segments degenerated before operation). There was no significant difference in gender, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), combined spondylolisthesis, and preoperative visual analogue scale (VAS) score of low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, and Oswestry disability index (ODI) score between the two groups ( P>0.05); the age of group A was significantly younger than that of group B ( t=-3.560, P=0.000). The operation time, intraoperative blood loss, hospitalization stay, and perioperative complications were recorded and compared. The VAS score of low back pain and leg pain, JOA score, and ODI score at last follow-up were used to evaluate the effectiveness. The incidence of ASD after operation was compared between the two groups, and logistic regression was used to analyze the independent risk factors affecting the occurrence of ASD after operation. Results There was no significant difference in operation time, intraoperative blood loss, and hospitalization stay between the two groups ( P>0.05). The incidence of perioperative complications in groups A and B was 13.3% and 20.0%, respectively, with no significant difference ( χ 2=1.506, P=0.220). Two groups of patients were followed up, the follow-up time of groups A and B was (24.9±8.8) months and (24.8±7.8) months, respectively, there was no significant difference ( t=0.050, P=0.960). At last follow-up, no adjacent segment disease was found in either group. There was no significant difference in Pfirrmann grade between the two groups at last follow-up ( P>0.05), and there was significant difference in Pfirrmann grade between the two groups before operation and at last follow-up ( P<0.001). At last follow-up, 21 cases (21.4%) in group A and 53 cases (62.4%) in group B had ASD, with significant difference ( χ 2=31.652, P=0.000). The main cause of ASD was the severity of adjacent spinal canal stenosis. The clinical scores of the two groups at last follow-up were significantly improved when compared with those before operation ( P<0.05). The JOA score of group A was significantly higher than that of group B at last follow-up ( P<0.05). In group B, the VAS score of low back pain and ODI score in patients with ASD after operation at last follow-up were significantly higher than those in patients without ASD ( P<0.05). logistic regression analysis showed that preoperative pre-existing degeneration and BMI were independent risk factors for ASD after operation ( P<0.05). Conclusion Pre-existing mild spinal stenosis in adjacent segment can significantly affect the effectiveness, and can significantly increase the risk of ASD early after operation. The main pathological type of ASD was the severity of adjacent segment spinal stenosis. For preoperative assessment of pre-existing degeneration, we should evaluate the overall degeneration of the adjacent segment of the spinal canal, rather than simply evaluating the degeneration of the adjacent disc and facet joints.
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Affiliation(s)
- Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, P.R.China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191,
| | - Yang Guo
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, P.R.China
| | - Siyu Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, P.R.China
| | - Fei Xu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, P.R.China
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, P.R.China
| | - Qiang Qi
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, P.R.China
| | - Zhaoqing Guo
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, P.R.China
| | - Yan Zeng
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, P.R.China
| | - Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, P.R.China
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Lee SY, Park HJ, Kim MS, Rho MH, Han CH. An initial experience with the use of whole body MRI for cancer screening and regular health checks. PLoS One 2018; 13:e0206681. [PMID: 30462666 PMCID: PMC6248944 DOI: 10.1371/journal.pone.0206681] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/17/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES We evaluated the utility of whole-body MRI (WB MRI) for cancer screening and other regular health evaluations. METHODS This retrospective study included 229 patients who underwent whole-body MRI as part of a routine health examination and cancer screening. The WB MRIs and radiologic reports were evaluated by a musculoskeletal radiologist, a neuroradiologist, and an abdominal radiologist. The consensus of their findings was characterized into three categories, as follows: suspicion of malignancy (category I); need for follow-up (category II); and no need for follow-up (category III). Any correlations between the abnormal findings and each study group were evaluated using the Mann-Whitney U test and chi-square test. RESULTS There were six category I lesions, among which two cases were found to involve malignancy. The most common category II findings were annular tears of the disc (14% of category II findings) and severe disc bulging or protrusion, followed by shoulder bursitis and uterine myoma. The most common category III finding was mild disc bulging or protrusion (47% of category III findings). CONCLUSIONS WB MRI can be used in cancer screening and for regular health evaluations. WB MRI not only provides information about potential malignancy, but also provides information regarding nonmalignant abnormalities that require further evaluation.
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Affiliation(s)
- So Yeon Lee
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Hee Jin Park
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
- * E-mail:
| | - Mi Sung Kim
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Myung Ho Rho
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Chul Hee Han
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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15
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An SJ, Choi SI, Kang KN, Yoon SH, Kim YU. Optimal cut-off points of lumbar pedicle thickness as a morphological parameter to predict lumbar spinal stenosis syndrome: a retrospective study. J Pain Res 2018; 11:1709-1714. [PMID: 30233228 PMCID: PMC6129025 DOI: 10.2147/jpr.s168990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Lumbar spinal stenosis syndrome (LSSS) is induced by factors such as ligamentum flavum hypertrophy, facet joint hypertrophy and disc degeneration. However, the role of lumbar pedicle (LP) in LSSS has yet to be evaluated. We devised a new morphological parameter called the lumbar pedicle thickness (LPT) to evaluate the connection between LSSS and the LP. We hypothesized that the LPT is a major morphological parameter in the diagnosis of LSSS. Patients and methods The LPT data were collected from 136 patients diagnosed with LSSS. A total of 99 control subjects underwent lumbar spine magnetic resonance imaging (MRI) as part of a detailed medical assessment. Axial T2-weighted magnetic resonance (MR) images were acquired from all the participants. Using our picture archiving and communication system, we analyzed the thickness of the LP at the level of L5 vertebra on MRI. Results The average LPT was 9.46±1.81 mm in the control group and 13.26±1.98 mm in the LSSS group. LSSS patients showed a significantly greater LPT (P<0.001) than the control group. The receiver operating characteristic (ROC) curve analysis showed an optimal cutoff point of 11.33 mm for the LPT, with 83.8% sensitivity, 83.8% specificity and area under the curve of 0.92 (95% confidence interval [CI], 0.89-0.96). Conclusion A higher LPT was associated with a higher possibility of LSSS, suggesting its importance in the evaluation of patients with LSSS.
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Affiliation(s)
- Sang Joon An
- Department of Neurology, Catholic Kwandong University of Korea College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea
| | - Soo Il Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea,
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Syn-Hae Yoon
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea,
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16
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Abstract
One of the major causes of lumbar spinal canal stenosis (LSCS) has been considered facet joint hypertrophy (FJH). However, a previous study asserted that "FJH" is a misnomer because common facet joints are no smaller than degenerative facet joints; however, this hypothesis has not been effectively demonstrated. Therefore, in order to verify that FJH is a misnomer in patients with LSCS, we devised new morphological parameters that we called facet joint thickness (FJT) and facet joint cross-sectional area (FJA).We collected FJT and FJA data from 114 patients with LSCS. A total of 86 control subjects underwent lumbar magnetic resonance imaging (MRI) as part of routine medical examinations, and axial T2-weighted MRI images were obtained from all participants. We measured FJT by drawing a line along the facet area and then measuring the narrowest point at L4-L5. We measured FJA as the whole cross-sectional area of the facet joint at the stenotic L4-L5 level.The average FJT was 1.60 ± 0.36 mm in the control group and 1.11 ± 0.32 mm in the LSCS group. The average FJA was 14.46 ± 5.17 mm in the control group and 9.31 ± 3.47 mm in the LSCS group. Patients with LSCS had significantly lower FJTs (P < .001) and FJAs (P < .001).FJH, a misnomer, should be renamed facet joint area narrowing. Using this terminology would eliminate confusion in descriptions of the facet joint.
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Affiliation(s)
| | - Mi Sook Seo
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
| | - Soo Il Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
| | - Tae-Ha Lim
- Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University College of Medicine
| | - So Jin Shin
- Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University College of Medicine
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
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Kushchayev SV, Glushko T, Jarraya M, Schuleri KH, Preul MC, Brooks ML, Teytelboym OM. ABCs of the degenerative spine. Insights Imaging 2018; 9:253-274. [PMID: 29569215 PMCID: PMC5893484 DOI: 10.1007/s13244-017-0584-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/28/2017] [Accepted: 12/06/2017] [Indexed: 12/13/2022] Open
Abstract
Degenerative changes in the spine have high medical and socioeconomic significance. Imaging of the degenerative spine is a frequent challenge in radiology. The pathogenesis of this degenerative process represents a biomechanically related continuum of alterations, which can be identified with different imaging modalities. The aim of this article is to review radiological findings involving the intervertebral discs, end plates, bone marrow changes, facet joints and the spinal canal in relation to the pathogenesis of degenerative changes in the spine. Findings are described in association with the clinical symptoms they may cause, with a brief review of the possible treatment options. The article provides an illustrated review on the topic for radiology residents. TEACHING POINTS • The adjacent vertebrae, intervertebral disc, ligaments and facet joints constitute a spinal unit. • Degenerative change is a response to insults, such as mechanical or metabolic injury. • Spine degeneration is a biomechanically related continuum of alterations evolving over time.
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Affiliation(s)
- Sergiy V. Kushchayev
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Tetiana Glushko
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Mohamed Jarraya
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Karl H. Schuleri
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Mark C. Preul
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 West Thomas Rd, Phoenix, AZ USA
| | - Michael L. Brooks
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Oleg M. Teytelboym
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
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Optimal Cut-Off Value of the Superior Articular Process Area as a Morphological Parameter to Predict Lumbar Foraminal Stenosis. Pain Res Manag 2017; 2017:7914836. [PMID: 28163566 PMCID: PMC5253487 DOI: 10.1155/2017/7914836] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/21/2016] [Indexed: 11/17/2022]
Abstract
Background. We devised a new morphological parameter called the superior articular process area (SAPA) to evaluate the connection between lumbar foraminal stenosis (LFS) and the superior articular process. Objective. We hypothesized that the SAPA is an important morphologic parameter in the diagnosis of LFS. Methods. All patients over 60 years of age were included. Data regarding the SAPA were collected from 137 patients with LFS. A total of 167 control subjects underwent lumbar magnetic resonance imaging (MRI) as part of a routine medical examination. We analyzed the cross-sectional area of the bone margin of the superior articular process at the level of L4-L5 facet joint in the axial plane. Results. The average SAPA was 96.3 ± 13.6 mm2 in the control group and 128.1 ± 17.2 mm2 in the LFS group. The LFS group was found to have significantly higher levels of SAPA (p < 0.001) in comparison to the control group. In the LFS group, the optimal cut-off value was 112.1 mm2, with 84.4% sensitivity, 83.9% specificity, and AUC of 0.94 (95% CI: 0.91-0.96). Conclusions. Higher SAPA values were associated with a higher possibility of LFS. These results are important in the evaluation of patients with LFS.
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Abstract
The prevalence of lumbar spinal stenosis is approximately 9.3%, with people most commonly affected in the sixth or seventh decade of life. Patients often have pain, cramping, and weakness in their legs that is worsened with standing and walking. Although the Spine Patient Outcomes Research Trial clearly demonstrated that surgery improves health-related quality of life, treatment for lumbar spinal stenosis varies widely from the type of decompression performed to the need for fusion. This variability can be attributed largely to the lack of an accepted classification system. A good classification system serves as a common language to define the severity of a condition, guide treatment, and facilitate clinical research.
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Is There an Association Between Radiological Severity of Lumbar Spinal Stenosis and Disability, Pain, or Surgical Outcome?: A Multicenter Observational Study. Spine (Phila Pa 1976) 2016; 41:E78-83. [PMID: 26352747 DOI: 10.1097/brs.0000000000001166] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Observational multicenter study. OBJECTIVE To evaluate if the severity of lumbar spinal stenosis (LSS) on magnetic resonance imaging (MRI) correlates with preoperative disability, pain, or surgical outcomes. SUMMARY OF BACKGROUND DATA Surgeons use the morphological appearance of LSS on MRI for clinical decision making. However, the associations between radiological severity of LSS and disability, pain, or surgical outcomes remain unclear. METHODS Evaluation of severity of LSS on preoperative MRI according to the Schizas morphological classification. Patient and treatment data were retrieved from the Norwegian Registry for Spine Surgery. Preopertaive outcome measures were Oswestry disability index (ODI) and numeric rating scale (NRS) scores for back and leg pain. Postopertive outcome measures were ODI and NRS scores for back and leg pain at 1 year, changes in ODI and NRS scores after treatment, duration of surgery, length of hospital stay, and perioperative complications. RESULTS Of 202 patients included, 7 were found to have mild stenosis, 38 had moderate stenosis, 108 had severe stenosis, and 49 had extreme stenosis. The radiological severity of LSS was not linked to preoperative ODI (P = 0.089), NRS back pain (P = 0.273), or NRS leg pain (P = 0.282) scores. There were no differences in ODI (P = 0.933), NRS back pain (P = 0.652), or NRS leg pain (P = 0.912) scores after 1 year. The radiological severity of stenosis was not associated with change in ODI (P = 0.494), NRS back pain (P = 0.235), NRS leg pain (P = 0.790), duration of surgery (P = 0.661), length of hospital stay (P = 0.739), or perioperative complication rates (P = 0.467). CONCLUSION Among patients who underwent decompressive surgery for LSS, radiological severity of stenosis was not associated with preoperative disability and pain, or clinical outcomes 1 year after surgery. In this patient group, the radiological severity of LSS has no clear clinical correlation and should therefore not be overemphasized in clinical decision making. LEVEL OF EVIDENCE 2.
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Kim S, Lee JW, Chai JW, Yoo HJ, Kang Y, Seo J, Ahn JM, Kang HS. A New MRI Grading System for Cervical Foraminal Stenosis Based on Axial T2-Weighted Images. Korean J Radiol 2015; 16:1294-302. [PMID: 26576119 PMCID: PMC4644751 DOI: 10.3348/kjr.2015.16.6.1294] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 07/17/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the reliability of a new magnetic resonance imaging (MRI) grading system for cervical neural foraminal stenosis (NFS). MATERIALS AND METHODS Cervical NFS at bilateral C4/5, C5/6, and C6/7 was classified into the following three grades based on the T2-weighted axial images: Grade 0 = absence of NFS, with the narrowest width of the neural foramen greater than the width of the extraforaminal nerve root (EFNR); Grade 1 = the narrowest width of the neural foramen the same or less than (but more than 50% of) the width of the EFNR; Grade 2 = the width of the neural foramen the same or less than 50% of the width of the EFNR. The MRIs of 96 patients who were over 60 years old (M:F = 50:46; mean age 68.4 years; range 61-86 years) were independently analyzed by seven radiologists. Interobserver and intraobserver agreements were analyzed using the percentage agreement, kappa statistics, and intraclass correlation coefficient (ICC). RESULTS For the distinction among the three individual grades at all six neural foramina, the ICC ranged from 0.68 to 0.73, indicating fair to good reproducibility. The percentage agreement ranged from 60.2% to 70.6%, and the kappa values (κ = 0.50-0.58) indicated fair to moderate agreement. The percentages of intraobserver agreement ranged from 85.4% to 93.8% (κ = 0.80-0.92), indicating near perfect agreement. CONCLUSION The new MRI grading system shows sufficient interobserver and intraobserver agreement to reliably assess cervical NFS.
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Affiliation(s)
- Sujin Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam 13620, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam 13620, Korea
| | - Jee Won Chai
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
| | - Hye Jin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jiwoon Seo
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam 13620, Korea
| | - Joong Mo Ahn
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam 13620, Korea
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22
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Weber C, Rao V, Gulati S, Kvistad KA, Nygaard ØP, Lønne G. Inter- and Intraobserver Agreement of Morphological Grading for Central Lumbar Spinal Stenosis on Magnetic Resonance Imaging. Global Spine J 2015; 5:406-10. [PMID: 26430595 PMCID: PMC4577324 DOI: 10.1055/s-0035-1551651] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/09/2015] [Indexed: 11/06/2022] Open
Abstract
Study Design Validation study of a morphological grading system for central lumbar spinal stenosis. Objective To evaluate and validate the inter- and intraobserver agreement of a morphological grading system for central lumbar spinal stenosis on magnetic resonance imaging between neurosurgeons and radiologists. Methods Two neurosurgeons and two radiologists independently assessed the morphological grading of lumbar spinal stenosis on pretreatment magnetic resonance imaging of 84 patients. Inter- and intrarater agreements were calculated by comparing the observers' evaluations level to level on the grading method. The results of both clinicians were compared with the assessment of both radiologists. Results On axial magnetic resonance images, 189 lumbar disk levels were evaluated for the grade of stenosis. The interobserver agreement between the clinicians was substantial. The interobserver agreement between clinician 1 and both radiologists was substantial, and it was moderate between clinician 2 and both radiologists. The clinicians' intraobserver agreement was almost perfect, and the radiologists' intraobserver agreement was substantial. Conclusions The interobserver agreement of this morphological grading for lumbar spinal stenosis was high between both the clinicians and radiologists, whereas the intraobserver agreement was almost perfect. Experienced clinicians may safely evaluate lumbar magnetic resonance images using this morphological grading for central lumbar spinal stenosis.
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Affiliation(s)
- Clemens Weber
- Department of Neurosurgery, Trondheim University Hospital, Trondheim, Norway,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway,National Advisory Unit on Spinal Surgery, Trondheim University Hospital, Trondheim, Norway,Address for correspondence Clemens Weber, MD Department of Neurosurgery, St. Olavs HospitalTrondheim University Hospital, Postboks 3250 Sluppen, 7005 TrondheimNorway
| | - Vidar Rao
- Department of Neurosurgery, Trondheim University Hospital, Trondheim, Norway,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sasha Gulati
- Department of Neurosurgery, Trondheim University Hospital, Trondheim, Norway,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway,National Advisory Unit on Spinal Surgery, Trondheim University Hospital, Trondheim, Norway
| | - Kjell A. Kvistad
- Department of Radiology, Trondheim University Hospital, Trondheim, Norway,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øystein P. Nygaard
- Department of Neurosurgery, Trondheim University Hospital, Trondheim, Norway,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway,National Advisory Unit on Spinal Surgery, Trondheim University Hospital, Trondheim, Norway
| | - Greger Lønne
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway,Department of Orthopedic Surgery, Innlandet Hospital Trust, Lillehammer, Norway
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