CORRELATION OF MAGNETIC RESONANCE IMAGING DATA (MRI) AND CLINICAL SIGNS IN THE CASE OF THE LUMBAR MEDULLARY CANAL STENOSIS
DOI:
https://doi.org/10.32782/2519-4151-2025-2-1Keywords:
stenosis of the spine, MRI examination.Abstract
Introduction. The stenosis of the spine may also occur as a congenital developmental problem with a small caliber of the spinal canal, but it is usually acquired, due to dislocation of the disc, hernia, hypertrophy of facets and hypertrophy of the flavum ligament. Patients with lumbar canal stenosis may have pain in the area of the buttocks or lower extremities pain, radiculopathy or neurogenic claudication. Pain in the lower back region is very common in patients with lumbar stenosis, it is not due to stenosis, but results from degenerative changes in the lumbar spine, which just leads to stenosis. The MRI without contrast enhancement is considered the best imaging way for the diagnosis of spinal stenosis. Aim is to assess clinical signs in correlation with Magnetic Resonance Imaging data in the case of lumbar spinal canal stenosis. Material and methods. The study included 51 patients with low back pain radiating to the leg. All patients underwent a clinical neurological examination and imaging examination (especially, MRI of the lumbar spine). Results. In 11 (91.7%) patients with imaging signs of spinal canal narrowing, a combination of degenerative changes was present, such as facet joint osteoarthritis, ligamentum flavum hypertrophy and intervertebral disc herniations (of which in one patient (9.1%) spinal canal narrowing was associated with L5-S1 intervertebral disc extrusion, and in 10 (90.9%) patients spinal canal narrowing was associated with various types of intervertebral disc prolapse with polysegmental localization). In only one patient (8.3%) was an association detected between spinal canal narrowing and cerebrospinal fluid flow disturbance, the spinal stenosis being congenital. Multivariate analysis with clinical symptoms suggested a correlation between lumbar spinal stenosis and loss of sensation in the lower limb, the significance threshold being only 10% (p < 0.10%). Cerebrospinal fluid flow disturbance, however, demonstrated a significant correlation with numbness (p < 0.10%). Conclusion. A correlation was determined between lumbar spinal canal stenosis and loss of sensitivity in the lower limb, the significance threshold being 10% (p < 0.10%). In the case of cerebrospinal fluid flow disturbance, a significant correlation with numbness was demonstrated (p < 0.10%).
References
Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J. 2013;13:734–43.
Genevay S, Atlas SJ, Katz JN. Variation in eligibility criteria from studies of radiculopathy due to a herniated disc and of neurogenic claudication due to lumbar spinal stenosis: A structured literature review. Spine (Phila Pa 1976). 2010;35:803–11.
de Graaf I, Prak A, Bierma-Zeinstra S, Thomas S, Peul W, Koes B, et al. Diagnosis of lumbar spinal stenosis: A systematic review of the accuracy of diagnostic tests. Spine (Phila Pa 1976). 2006;31:1168–76.
Saint-Louis LA. Lumbar spinal stenosis assessment with computed tomography, magnetic resonance imaging, and myelography. Clin Orthop Relat Res. 2001;384:122–36. 5. Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med. 2008;358:818–25.
Melrose J, Smith SM, Appleyard RC, Little CB. Aggrecan, versican and type VI collagen are components of annulus trans-lamellar cross-bridges in the intervertebral disc. Eur Spine J.2008;17:314–324.
Bartynski WS, Petropoulou KA. The MR imaging features and clinical correlates in low back pain-related syndromes Magn Reson Imaging Clin N Am, 15 (2007), pp. 137–154.
Sirvanci M, Bhatia M, Ganiyusufoglu KA, et al. Degenerative lumbar spinal stenosis: correlation with Oswestry disability index and MR imaging Eur Spine J, 17 (2008), pp. 679–685.
Griffith JF, Huang J, Law SW, Xiao F, Leung JC, Wang D, et al. Population reference range for developmental lumbar spinal canal size Quant Imaging Med Surg, 6 (2016), pp. 671–679.
Chad DA. Lumbar spinal stenosis. Neurol Clin, 25 (2007), pp. 407–410.
Jespersen SM, Hansen ES, Høy K, Christensen KO, Lindblad BE, Ahrensberg JJ, et al. Two-level spinal stenosis in minipigs. Hemodynamic effects of exercise. Spine. 1995;20(24):2765–73. doi: 10.1097/00007632-199512150-00020.
Mao GP, Konno S, Arai I, Olmarker KK, Kikuchi SS. Chronic double-level cauda equina compression. An experimental study on the dog cauda equina with analyses of nerve conduction velocity. Spine. 1998;23(15):1641–4. doi: 10.1097/00007632-19980 8010-00004.
Olmarker K, Rydevik B, Hansson T, Holm S. Compression- induced changes of the nutritional supply to the porcine cauda equina. J Spinal Disord. 1990 Mar;3(1):25–9.
Olmarker K, Holm S, Rydevik B. Importance of compression onset rate for the degree of impairment of impulse propagation in experimental compression injury of the porcine cauda equina. Spine. 1990 May;15(5):416–9. doi: 10.1097/00007632-1990 05000-00013.
Sairyo K, Biyani A, Goel V, Leaman D, Booth R, Jr, Thomas J, et al. Pathomechanism of ligamentum flavum hypertrophy: a multidisciplinary investigation based on clinical, biomechanical, histologic, and biologic assessments. Spine. 2005 Dec 1;30(23):2649–56. doi: 10.1097/01.brs.0000188117.77657.ee.
Jenis LG, An HS. Spine update. Lumbar foraminal stenosis. Spine. 2000;25(3):389–94. doi: 10.1097/00007632-200002 010-00022.
Matsumoto M, Watanabe K, Tsuji T, Ishii K, Takaishi H, Nakamura M, et al. Nocturnal leg cramps: a common complaint in patients with lumbar spinal canal stenosis. Spine. 2009 Mar 1;34(5):E189–94. doi: 10.1097/BRS.0b013e31818f953c.
Inui Y, Doita M, Ouchi K, Tsukuda M, Fujita N, Kurosaka M. Clinical and radiologic features of lumbar spinal stenosis and disc herniation with neuropathic bladder. Spine. 2004 Apr 15;29(8):869–73. doi: 10.1097/00007632-200404150-00009.
Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine. 1992 Jan;17(1):1–8. doi: 10.1097/00007632-199201000-000 01.
Katz JN, Dalgas M, Stucki GG, Katz NP, Bayley J, Fossel AH, et al. Degenerative lumbar spinal stenosis. Diagnostic value of the history and physical examination. Arthritis and rheumatism. 1995;38(9):1236–41. doi: 10.1002/art.1780380910.
North American Spine Society Clinical Guidelines. III. Definition and Natural History of Degenerative Lumbar Spinal Stenosis [homepage on the Internet]. North American Spine Society; 2011. Available from: https://www.spine.org/Portals/0/Assets/ Downloads/ResearchClinicalCare/Guidelines/LumbarStenosis. pdf (Accessed May 1, 2020).
Siebert E, Prüss H, Klingebiel R, et al. Lumbar spinal stenosis: syndrome, diagnostics and treatment. Nat Rev Neurol, 2009;5:392–403.
Kushchayev SV, Glushko T, Jarraya M, et al. ABCs of the degenerative spine. Insights Imaging, 2018;9:253–27.
Splettstößer A, Khan MF, Zimmermann B, et al. Correlation of lumbar lateral recess stenosis in magnetic resonance imaging and clinical symptoms. World J Radiol, 2017;9: 223–229.
Igarashi A, Kikuchi S, Konno S. Correlation between inflammatory cytokines released from the lumbar facet joint tissue and symptoms in degenerative lumbar spinal disorders. J Orthop Sci, 2007;12:154–160.
Vardeh D, Mannion RJ, Woolf CJ. Toward a Mechanism- Based Approach to Pain Diagnosis. J Pain, 2016;17:T50–T69.
Tomkins-Lane C, Melloh M, Lurie J. ISSLS Prize Winner: Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis: Results of an International Delphi Study. Spine (Phila Pa 1976) 2016;41(15):1239–1246. doi: 10.1097/BRS.0000000000001476.
