Лумбална спинална стеноза - споредба меѓу наодот на магнетна резонанца и степенот на онеспособеност кај пациентите

Abstract

TYPE OF STUDY: Prospective radiologic study BACKGROUND AND AIM: Radiologic stenosis is commonly assessed by measuring the AP diameter of the spinal canal and dural sac – cross sectional area (DSCSA), at various levels of lumbar spinal canal. Great variation is observed between the dural sac area (DSCSA) and the AP diameter in clinical evaluation between symptomatic and asymptomatic patients. It is not precisely defined which radiological degree of lumbar spinal stenosis is considered to be symptomatic, nor is there always consistency between clinical presentation and radiological findings. Therefore, a correlation between radiologically quantitative and qualitative grading of severity of LSS, based on measuring the AP diameter of the spinal canal, DSCSA and morphologic appearance of the dural sac seen on axial T2 MR images, and ODI index was made. The results have shown that both clinical and MRI findings are very important in establishing a reliable diagnosis and making the right decision when it comes to choosing an adequate treatment – surgical or conservative. The aim of this study was to establish the relationship and correlation between quantitative grading of severity of lumbar spinal stenosis by measuring dural sac cross-sectional area (DSCSA), anteroposterior (AP) diameter of the spinal canal and qualitative grading based on morphology of the dural sac with severity of self-assessed Oswestry Disability Index. RESULTS: The results of the study showed a statistically significant difference between the rate of LSS determined according to the median values of the AP diameter (mm) and the degree of disability determined by the ODI score (p = 0.0084). Statistical analysis also showed that there was a statistically significant difference between the level of LSS determined by the values of DSCSA in mm2 and the degree of disability in patients determined by ODI score (p = 0.0035). The degree of compliance between the degrees of spinal stenosis obtained by the smallest medial AP diameter (mm) in relation to the ODI score, as well as the degrees of spinal stenosis obtained by the values of DSCSA (mm2) relative to the ODI score expressed through Cohen’s Kappa coefficient showed no correlation between the obtained degrees with the different quantitative methods. For testing the results obtained by the Cohen’s Kappa coefficient (and between the different degrees of spinal stenosis of the total number of subjects), the values were significantly greater than p = 0.05 at the confidence interval CL = 95%. Regarding the degree of spinal stenosis according to the qualitative criterion - coefficient of lumbar spinal stenosis and the degree of stenosis according to ODI score there was no statistically significant difference (Kruskal-Wallis ANOVA: H = 0.610 p = 0.7368), which means that there is a correlation between these two methods in determining the degree of central spinal stenosis. CONCLUSION: Lumbar spinal stenosis is a clinical-radiological syndrome that cannot be evaluated only by radiological diagnostic procedures.There is no significant correlation between the MRI finding identified through the quantitative criteria and the degree of disability of patients with lumbar spinal stenosis, but there is a correlation between the qualitative criterion - coefficient of lumbar spinal stenosis and ODI score. In quantitative and qualitative assessment of the degree of lumbar spinal stenosis, and the decision for further treatment of patients (conservative or surgical), the clinical picture as well as the comparison of the findings of disability and MRI findings, which determine the exact level of the most distinct spinal stenosis that might be a candidate for spinal decompressive intervention.