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Outcomes of decompression for lumbar spinal canal stenosis based upon preoperative radiographic severity.

Weiner BK, Patel NM, Walker MA - J Orthop Surg Res (2007)

Bottom Line: No patients (0 of 14) with a greater than 50% reduction in cross-sectional area on pre-operative MRI had unsatisfactory outcomes.In contrast, outcomes for patients with less than or equal to 50% reduction in cross-sectional area had unsatifactory outcomes in 6 of 13 cases, with all but one negative outcome having a cross-sectional area reduction between 32% and 47%.The findings suggest that there appears to be a relationship between severity of stenosis and outcomes of decompressive surgery such that patients with a greater than 50% reduction in cross sectional area are more likely to have a successful outcome.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Spinal Surgery, Department of Orthopaedics, The Methodist Hospital/Texas Medical Center, Houston, Texas, USA. bkweiner@tmh.tmc.edu

ABSTRACT

Background: The relationship between severity of preoperative radiographic findings and surgical outcomes following decompression for lumbar degenerative spinal canal stenosis is unclear. Our aim in this paper was to gain insight into this relationship. We determined pre-operative radiographic severity on MRI scans using strict methodological controls and correlated such severity with post-operative outcomes using prospectively collected data.

Methods: Twenty-seven consecutive patients undergoing decompression for isolated degenerative spinal canal stenosis at L4-L5 were included. We measured cross-sectional area on MRI using the technique of Hamanishi. We categorized the severity of stenosis using Laurencin and Lipson's 'Stenosis Ratio'. We determined pre-operative status (prospectively) and post-operative outcomes using Weiner and Fraser's 'Neurogenic Claudication Outcome Score'. We determined patient satisfaction using standardized questionnaires. Each of these is a validated measure. Formal statistical evaluation was undertaken.

Results: No patients (0 of 14) with a greater than 50% reduction in cross-sectional area on pre-operative MRI had unsatisfactory outcomes. In contrast, outcomes for patients with less than or equal to 50% reduction in cross-sectional area had unsatifactory outcomes in 6 of 13 cases, with all but one negative outcome having a cross-sectional area reduction between 32% and 47%.

Conclusion: The findings suggest that there appears to be a relationship between severity of stenosis and outcomes of decompressive surgery such that patients with a greater than 50% reduction in cross sectional area are more likely to have a successful outcome.

No MeSH data available.


Related in: MedlinePlus

Hamanishi Technique to Measure Cross-sectional Area on Axial MRI.
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Figure 2: Hamanishi Technique to Measure Cross-sectional Area on Axial MRI.

Mentions: We used the technique described by Hamanishi[16] (Figure 2) to determine the cross sectional area at the level demonstrating the most severe stenosis (using the method) and at the pedicle level uninvolved by stenosis. The 'stenosis ratio', as described by Lurencin and Lipson(14), was then used to determine the severity of stenosis. This ratio is the cross-sectional area of the canal at the axial MRI image with greatest neurologic compression (in these cases, L4-L5 disc level) over the cross-sectional area at the pedicle level above (in these cases, the pedicle level of L4). Two independent surgeons performed the measurements and calculations. They were blinded to each other's measurements as well as the patient's outcomes.


Outcomes of decompression for lumbar spinal canal stenosis based upon preoperative radiographic severity.

Weiner BK, Patel NM, Walker MA - J Orthop Surg Res (2007)

Hamanishi Technique to Measure Cross-sectional Area on Axial MRI.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1828049&req=5

Figure 2: Hamanishi Technique to Measure Cross-sectional Area on Axial MRI.
Mentions: We used the technique described by Hamanishi[16] (Figure 2) to determine the cross sectional area at the level demonstrating the most severe stenosis (using the method) and at the pedicle level uninvolved by stenosis. The 'stenosis ratio', as described by Lurencin and Lipson(14), was then used to determine the severity of stenosis. This ratio is the cross-sectional area of the canal at the axial MRI image with greatest neurologic compression (in these cases, L4-L5 disc level) over the cross-sectional area at the pedicle level above (in these cases, the pedicle level of L4). Two independent surgeons performed the measurements and calculations. They were blinded to each other's measurements as well as the patient's outcomes.

Bottom Line: No patients (0 of 14) with a greater than 50% reduction in cross-sectional area on pre-operative MRI had unsatisfactory outcomes.In contrast, outcomes for patients with less than or equal to 50% reduction in cross-sectional area had unsatifactory outcomes in 6 of 13 cases, with all but one negative outcome having a cross-sectional area reduction between 32% and 47%.The findings suggest that there appears to be a relationship between severity of stenosis and outcomes of decompressive surgery such that patients with a greater than 50% reduction in cross sectional area are more likely to have a successful outcome.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Spinal Surgery, Department of Orthopaedics, The Methodist Hospital/Texas Medical Center, Houston, Texas, USA. bkweiner@tmh.tmc.edu

ABSTRACT

Background: The relationship between severity of preoperative radiographic findings and surgical outcomes following decompression for lumbar degenerative spinal canal stenosis is unclear. Our aim in this paper was to gain insight into this relationship. We determined pre-operative radiographic severity on MRI scans using strict methodological controls and correlated such severity with post-operative outcomes using prospectively collected data.

Methods: Twenty-seven consecutive patients undergoing decompression for isolated degenerative spinal canal stenosis at L4-L5 were included. We measured cross-sectional area on MRI using the technique of Hamanishi. We categorized the severity of stenosis using Laurencin and Lipson's 'Stenosis Ratio'. We determined pre-operative status (prospectively) and post-operative outcomes using Weiner and Fraser's 'Neurogenic Claudication Outcome Score'. We determined patient satisfaction using standardized questionnaires. Each of these is a validated measure. Formal statistical evaluation was undertaken.

Results: No patients (0 of 14) with a greater than 50% reduction in cross-sectional area on pre-operative MRI had unsatisfactory outcomes. In contrast, outcomes for patients with less than or equal to 50% reduction in cross-sectional area had unsatifactory outcomes in 6 of 13 cases, with all but one negative outcome having a cross-sectional area reduction between 32% and 47%.

Conclusion: The findings suggest that there appears to be a relationship between severity of stenosis and outcomes of decompressive surgery such that patients with a greater than 50% reduction in cross sectional area are more likely to have a successful outcome.

No MeSH data available.


Related in: MedlinePlus