Tomkins-Lane Christy C, Battié Michele C, Hu Richard, Macedo Luciana
Mount Royal University, Calgary, AB, Canada.
Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
J Back Musculoskelet Rehabil. 2014;27(2):223-9. doi: 10.3233/BMR-130440.
There is no clear picture of pathoanatomy in clinically diagnosed LSS. Findings in the literature regarding imaging in LSS are heterogeneous.
Characterize the pathoanatomy of LSS, as reported in the radiology reports, for a large community-based sample of patients with the clinical diagnosis of LSS.
Retrospective review of clinical radiology reports. The sample comprised patients 40 years of age or older, with clinically diagnosed LSS. Radiology reports for lumbar MRI were obtained and data were extracted pertaining to the type and location of LSS.
173 subjects with a mean age of 66.2 ± 11.7 years were included (61% women). 68.2% had mixed stenosis, 19.1% had central stenosis only, and 12.7% had lateral stenosis only. By level, the most prevalent findings were at L4/5 (93%), L3/4 (66%) and L5/S1 (49%). This pattern was different in those with lateral stenosis only, where the proportion of findings at L5/S1 was higher than at L3/4. 156 subjects (90.2%) had findings of at least moderate severity. Considering moderate-severe findings only, 31% had mixed stenosis and 40.0% had multi-level findings (90.5% at adjacent segments). When mild findings were included for subjects with at least one moderate-severe finding the rate of mixed stenosis increased to 59%, and multi-level stenosis to 68.6%. The most common multi-level combinations were L3/4 and L4/5 for two-level stenosis and L2/3 through L4/5 for three-level.
Results of this study confirm a number of pathoanatomical patterns in people diagnosed with LSS, including a high proportion of stenosis at L4/5, followed by L3/4 and L5/S1. Results also suggest a high prevalence of multi-level stenosis at adjacent segments. The prevalence of mixed stenosis varied from 31% to 68.2%; inclusion of mild findings resulted in a higher rate of both mixed and multi-level stenosis, compared to analysis of moderate-severe findings only. These results may guide future studies on LSS pathophysiology, by focusing attention toward the most prevalent radiological findings.
临床诊断的腰椎管狭窄症（LSS）的病理解剖情况尚不清楚。文献中关于LSS影像学的研究结果存在异质性。
对于大量临床诊断为LSS的社区患者样本，描述放射学报告中LSS的病理解剖特征。
回顾性分析临床放射学报告。样本包括年龄在40岁及以上、临床诊断为LSS的患者。获取腰椎MRI的放射学报告，并提取有关LSS类型和位置的数据。
纳入173名受试者，平均年龄为66.2±11.7岁（61%为女性）。68.2%有混合性狭窄，19.1%仅有中央型狭窄，12.7%仅有侧隐窝狭窄。按节段来看，最常见的病变位于L4/5（93%）、L3/4（66%）和L5/S1（49%）。仅侧隐窝狭窄的患者情况有所不同，L5/S1节段的病变比例高于L3/4节段。156名受试者（90.2%）有至少中度严重程度的病变。仅考虑中度至重度病变时，31%有混合性狭窄，40.0%有多节段病变（90.5%位于相邻节段）。对于至少有一项中度至重度病变的受试者，若纳入轻度病变，混合性狭窄的比例增至59%，多节段狭窄的比例增至68.6%。最常见的多节段组合为：两节段狭窄时为L3/4和L4/5，三节段狭窄时为L2/3至L4/5。
本研究结果证实了诊断为LSS的患者存在多种病理解剖模式，包括L4/5节段狭窄比例较高，其次是L3/4和L5/S1节段。结果还表明相邻节段多节段狭窄的患病率较高。混合性狭窄的患病率从31%到68.2%不等；与仅分析中度至重度病变相比，纳入轻度病变会使混合性和多节段狭窄的发生率更高。这些结果可能通过关注最常见的放射学表现，为未来LSS病理生理学研究提供指导。
