Comparison of Surgeon Rating of Severity of Stenosis Using MRI, Dural Cross-Sectional Area and Functional Outcome Scores

• Published in: World neurosurgery
• Main Authors: Marawar, Satyajit V., MBBS, Ordway, Nathaniel R., MS, PE, Madom, Ian A., MD, Tallarico, Richard A., MD, Palumbo, Mark, MD, Metkar, Umesh, MD, Wang, Dongliang, PhD, Huang, Danning, MA, Lavelle, William F., MD
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Neurosurgery; Oswestry Disability Index; MRI; Visual Analog Scale (VAS); Zurich claudication questionnaire; Visual Analog Scale; VAS; SF-36; Short Form 36 (SF-36); Body mass index; dural cross sectional area; Oswestry Disability Index (ODI); radiological grading; lumbar spinal stenosis; Magnetic resonance imaging; ODI; Short Form 36; BMI
• ISSN: 1878-8750
• DOI: 10.1016/j.wneu.2016.08.093

Abstract Objective To determine the relationship between the severity of stenosis graded using both surgeon’s visual assessment of spinal stenosis as well as measurement of dural cross sectional area on MRI, with the patient's disability. Methods Seven fellowship trained spine surgeons reviewed MRI studies retrospectively of 30 symptomatic consecutive patients with lumbar stenosis and graded stenosis in the central canal, the lateral recess and the foramen at T12-L1 to L5-S1 as; none, mild, moderate, or severe. Dural cross sectional area was measured at each level from T12-L1 to L5-S1. All patients completed the questionnaires for ODI, SF-36, and recorded VAS scores for leg and back pain, and symptom severity scale of the Zurich claudication questionnaire. Results There was positive correlation between the right leg pain VAS score and the mean surgeon grades for central and lateral recess stenosis at L4-L5, and lateral recess stenosis at L5-S1. Except for a positive correlation between role physical score and surgeon grade for lateral recess stenosis at L5-S1, we found no correlation between the surgeons’ grading of stenosis at any level with the ODI or SF-36. We found no correlation between the dural cross sectional area with the ODI or SF-36. We did not find any correlation between the Zurich symptom severity scale and surgeon’s grading of stenosis at any level. Conclusion Although surgeons rely on visual assessment of the severity of stenosis while making surgical decisions, we found objective and subjective imaging parameters to grade severity of stenosis did not consistently indicate patient’s disability level.