Cheung Jason Pui-Yin, Samartzis Dino, Shigematsu Hideki, Cheung Kenneth Man-Chee
*Department of Orthopaedics & Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China; and †Department of Orthopaedics Surgery, Nara Medical University, Kahihara, Nara, Japan.
Spine (Phila Pa 1976). 2014 Jun 1;39(13):1067-76. doi: 10.1097/BRS.0000000000000335.
Case-control study.
The aim of this study was to define clinically relevant relative and critical (absolute) magnetic resonance imaging values of lumbar spinal stenosis in a cohort of 100 surgical cases and 100 asymptomatic controls.
Developmental spinal stenosis is a precipitating factor in patients presenting with lumbar canal stenosis. Yet, due to a lack of agreement on definitions and methods of assessment, as well as ethnic-specific normative values, its prevalence and significance is not known.
This was a case-control study comparing 100 age and sex-matched asymptomatic, volunteers with that of 100 patients who underwent surgery for spinal stenosis. All patients were of Chinese ethnicity and their details were blinded to 2 observers. Spinal stenosis parameters were measured on the basis of axial (pedicle level) and sagittal (midsagittal) magnetic resonance images.
Anteroposterior spinal canal diameters change with levels. At each level, patients were found to have significantly narrower anteroposterior canal diameters than controls. By use of receiver operating characteristic curve, we defined developmental spinal stenosis if the anteroposterior canal diameter was at L1 <20 mm, L2 <19 mm, L3 <19 mm, L4 <17 mm, L5 <16 mm, and at S1 <16 mm on the basis of a value including 50% of controls and demonstrated best sensitivity and specificity. Furthermore, for L4, L5, and S1, critical stenosis values could be defined, below which almost all subjects needed surgery, these were L4 <14 mm, L5 <14 mm, and S1 <12 mm.
This is the largest magnetic resonance imaging-based study with standardized measurements and comparable groups to determine clinically relevant magnetic resonance imaging criteria for lumbar spinal stenosis. The findings strongly suggest that developmental stenosis plays an important role in the pathogenesis of symptomatic spinal stenosis. Critical values of stenosis below which symptoms were highly likely were defined. These will need to be validated by longitudinal studies in future. However, they may possess clinical utility in determining the appropriate levels requiring canal-widening surgery.
病例对照研究。
本研究旨在确定100例接受手术治疗的病例和100例无症状对照人群中腰椎管狭窄症临床相关的相对及临界（绝对）磁共振成像值。
发育性椎管狭窄是腰椎管狭窄症患者的一个促发因素。然而，由于在定义、评估方法以及特定种族的正常参考值方面缺乏共识，其患病率及意义尚不明确。
这是一项病例对照研究，将100名年龄和性别匹配的无症状志愿者与100例接受椎管狭窄手术的患者进行比较。所有患者均为中国汉族，其详细信息对两名观察者保密。基于轴向（椎弓根水平）和矢状面（正中矢状面）磁共振图像测量椎管狭窄参数。
椎管前后径随节段变化。在每个节段，发现患者的椎管前后径明显窄于对照组。通过使用受试者工作特征曲线，我们将发育性椎管狭窄定义为：基于包含50%对照组的数值，L1节段椎管前后径<20mm，L2节段<19mm，L3节段<19mm，L4节段<17mm，L5节段<16mm，S1节段<16mm，此定义显示出最佳的敏感性和特异性。此外，对于L4、L5和S1节段，可以定义临界狭窄值，低于该值几乎所有受试者都需要手术，这些值分别为L4<14mm，L5<14mm，S1<12mm。
这是基于磁共振成像的最大规模研究，采用标准化测量方法并设置了可比组，以确定腰椎管狭窄症临床相关的磁共振成像标准。研究结果强烈表明，发育性狭窄在有症状的椎管狭窄发病机制中起重要作用。定义了低于该值很可能出现症状的临界狭窄值。未来需要通过纵向研究对其进行验证。然而，它们在确定需要进行椎管扩大手术的合适节段方面可能具有临床应用价值。
3级。
