Predictive factors of symptomatic lumbar canal stenosis in patients after surgery for cervical spondylotic myelopathy

Exploring Variations in Lumbar Canal Width: An MRI Study on Asymptomatic Patients by Age and Gender

Background: Lumbar spinal stenosis is a common degenerative condition, especially in older adults, leading to significant morbidity. Age, gender, and lumbar level variations in spinal canal width are critical in assessing stenosis risk. Many patients exhibit radiographic narrowing without clinical symptoms. This study analyzed the risk of lumbar stenosis by age, gender, and lumbar levels (L1-S1) using the MRI of patients without clinical signs of narrowing. Materials and Methods: This retrospective study included 120 patients, aged 20 to 75, who underwent lumbar MRI for unrelated reasons. Spinal canal widths were measured at five lumbar levels (L1-2 to L5-S1), and stenosis risk was classified as low, borderline, or high based on narrowing thresholds. Data were grouped by age and gender to assess the stenosis risk distribution. Results: The analysis revealed a progressive increase in stenosis risk from the upper to lower lumbar levels. At L4-5 and L5-S1, females aged 61-75 exhibited the highest proportions in borderline- and high-risk categories. While most patients were classified as low risk, many older patients showed radiographic narrowing without clinical symptoms. Males generally had wider canals and lower risk. Conclusions: Age and gender significantly impact lumbar stenosis risk, particularly in older females. The findings highlight the importance of clinical correlation despite radiographic evidence of stenosis and suggest potential for AI-based detection systems in enhancing assessments of spinal canal narrowing.

Long-term functional outcome of surgical treatment for degenerative cervical myelopathy

OBJECTIVE

Degenerative cervical myelopathy (DCM) is a major global cause of spinal cord dysfunction. Surgical treatment is considered a safe and effective way to improve functional outcome, although information about long-term functional outcome remains scarce despite increasing longevity. The objective of this study was to describe functional outcome 10 years after surgery for DCM.

METHODS

A prospective observational cohort study was undertaken in a university-affiliated neurosurgery department. All patients who underwent surgery for DCM between 2008 and 2010 as part of the multicenter Cervical Spondylotic Myelopathy International trial were included. Participants were approached for additional virtual assessment 10 years after surgery. Functional outcome was assessed according to the modified Japanese Orthopaedic Association (mJOA; scores 0-18) score at baseline and 1, 2, and 10 years after surgery. The minimal clinically important difference was defined as 1-, 2-, or 3-point improvement for mild, moderate, and severe myelopathy, respectively. Outcome was considered durable when stabilization or improvement after 2 years was maintained at 10 years. Self-evaluated effect of surgery was assessed using a 4-point Likert-like scale. Demographic, clinical, and surgical data were compared between groups that worsened and improved or remained stable using descriptive statistics. Functional outcome was compared between various time points during follow-up with linear mixed models.

RESULTS

Of the 42 originally included patients, 37 participated at follow-up (11.9% loss to follow-up, 100% response rate). The mean patient age was 56.1 years, and 42.9% of patients were female. Surgical approaches were anterior (76.2%), posterior (21.4%), or posterior with fusion (2.4%). The mean follow-up was 10.8 years (range 10-12 years). The mean mJOA score increased significantly from 13.1 (SD 2.3) at baseline to 14.2 (SD 3.3) at 10 years (p = 0.01). A minimal clinically important difference was achieved in 54.1%, and stabilization of functional status was maintained in 75.0% in the long term. Patients who worsened were older (median 63 vs 52 years, p < 0.01) and had more comorbidities (70.0% vs 25.9%, p < 0.01). A beneficial effect of surgery was self-reported by 78.3% of patients.

CONCLUSIONS

Surgical treatment for DCM results in satisfactory improvement of functional outcome that is maintained at 10-year follow-up.

Prevalence and Predictive Factors of Asymptomatic Spondylotic Cervical Spinal Stenosis in Patients with Symptomatic Lumbar Spinal Stenosis

OBJECTIVE

We performed a retrospective cohort study to investigate the prevalence of and risk factors for asymptomatic spondylotic cervical spinal stenosis (ASCSS) in the setting of lumbar spinal stenosis (LSS).

METHODS

A total of 114 patients with a diagnosis of LSS without cervical myelopathy and radiculopathy were grouped into ASCSS and non-ASCSS groups. The medical data and radiological parameters, including age, sex, body mass index, Charlson comorbidity index, symptom duration, redundant nerve roots, dural sac cross-sectional area (DCSA), facet joint angle, lumbar lordosis angle (LLA), pelvic incidence (PI), Torg-Pavlov ratio, and lumbosacral transitional vertebrae, were analyzed. The lumbar stenosis index and cervical stenosis index of the 114 patients were also analyzed.

RESULTS

ASCSS occurred in 70 of the 114 patients with LSS (61.4%). The two groups showed significant differences in symptom duration, redundant nerve roots, LLA, DCSA, and PI. On multivariate logistic regression analysis, an LLA >35.85° (P < 0.001) and a DCSA <84.50 mm² (P = 0.003) were independently associated with ASCSS. The multi-index receiver operating characteristic curve showed that the area under the curve for predicted probability was 0.805 (P < 0.001). Linear regression analysis revealed that cervical stenosis index significantly and positively correlated with the lumbar stenosis index (r = 0.430; P < 0.001).

CONCLUSIONS

Our findings suggest that an LLA >35.85° and a DCSA <84.50 mm² are risk factors for the development of ASCSS. For LSS patients with an enlarged LLA and reduced DSCA, a whole spinal magnetic resonance imaging examination should be performed.

Evaluation and Treatment of Tandem Spinal Stenosis

Tandem spinal stenosis (TSS) refers to simultaneous narrowing of noncontiguous regions of the spinal canal, typically the cervical and lumbar region. Symptomatic TSS may be present in more than 10% of patients presenting with spinal symptoms secondary to stenosis in any one region. Clinical presentation may present challenges because of a mixture of upper and lower motor neuron lesions that can confuse and mislead the clinician. Stenosis at another level may only be detected late, when there is failure to improve after treatment, and, if not detected, can result in either poor treatment outcomes or catastrophic complications. There is no uniform agreement in the management of TSS, and the reported surgical strategies include both simultaneous and staged approaches with each having positive and negative features. This article aims to provide the reader with details on the prevalence, evaluation, and guidance in treatment strategy for TSS.