Soman Shardul Madhav, Chokshi Jimmy, Chhatrala Naitik, Tharadara Gulam Haider, Prabhakar Mukund
Department of Orthopaedics, Government Spine Institute and Paraplegia Hospital, Ahmedabad, India.
Department of Orthopaedics, BJ Medical College and Civil Hospital, Ahmedabad, India.
Asian Spine J. 2017 Apr;11(2):278-284. doi: 10.4184/asj.2017.11.2.278. Epub 2017 Apr 12.
This is a prospective study that was undertaken at a single centre and involved 80 consecutive patients diagnosed with lumbar spinal stenosis (LSS).
The aim of the study was to assess the efficacy of a qualitative grading system as seen on magnetic resonance imaging (MRI) as a tool in the management of multilevel LSS.
LSS diagnosis is clinical but is usually radiologically supplemented. However, there are often multilevel radiological findings with non-specific or atypical clinical features. We used a qualitative grading system to help in the decision-making process of the management of patients with multilevel LSS.
80 patients with LSS were treated with decompression and prospectively followed-up for a minimum of 12 months. All had failed conservative treatment. Qualitative grading of LSS severity was based on the dural sac in T2 weighted axial MRI images at all disc levels and was done from L1-2 to L5-S1 (n=400). Functional outcome was assessed using the Oswestry disability index (ODI).
The mean patient age was 56.6 years, with a gender ratio of 0.6:1. Forty patients had degenerative LSS and 40 had degenerative spondylolysthesis. A total of 178 levels were decompressed, the majority of which were L4-L5 (43.82%), followed by L5-S1 (41.57%). According to our qualitative grading system, grade D stenosis (53.93%) was decompressed most frequently, followed by grade C stenosis (41.57%). The average preoperative ODI score was 58.55%, which later reduced to 19.15%. Seventy percent of patients achieved excellent results, whereas 30% achieved good results.
Morphological grading is a useful tool in decision making in surgery for multilevel LSS. Grade C and D stenosis should be decompressed, whereas A and B should not be, unless clinically justified.
这是一项在单一中心进行的前瞻性研究，纳入了80例连续诊断为腰椎管狭窄症（LSS）的患者。
本研究旨在评估磁共振成像（MRI）上的定性分级系统作为多节段LSS治疗工具的有效性。
LSS的诊断以临床症状为主，但通常需影像学检查辅助。然而，多节段影像学表现常伴有非特异性或不典型的临床特征。我们使用定性分级系统来辅助多节段LSS患者的治疗决策过程。
80例LSS患者接受减压治疗，并进行前瞻性随访，随访时间至少为12个月。所有患者均经保守治疗无效。LSS严重程度的定性分级基于所有椎间盘水平的T2加权轴位MRI图像上的硬膜囊情况，从L1-2至L5-S1进行评估（共400个节段）。使用Oswestry功能障碍指数（ODI）评估功能结局。
患者平均年龄为56.6岁，性别比为0.6:1。40例患者为退变性LSS，40例为退变性腰椎滑脱。总共减压了178个节段，其中大部分为L4-L5（43.82%），其次是L5-S1（41.57%）。根据我们的定性分级系统，D级狭窄（53.93%）减压最为频繁，其次是C级狭窄（41.57%）。术前ODI平均评分为58.55%，术后降至19.15%。70%的患者取得了优异的效果，30%的患者取得了良好的效果。
形态学分级是多节段LSS手术决策中的有用工具。除非有临床指征，C级和D级狭窄应进行减压，而A级和B级则不应减压。
