Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China.
World Neurosurg. 2020 Feb;134:e866-e873. doi: 10.1016/j.wneu.2019.11.011. Epub 2019 Nov 9.
To assess the dynamic change of the dural sac size in patients with lumbar spinal stenosis (LSS) from supine to standing position and their correlation with clinical symptoms.
A total of 110 patients with LSS were prospectively enrolled to undergo both supine (0°) and standing (78°) magnetic resonance imaging (MRI). Dural sac cross-sectional area (DCSA) and dural sac anteroposterior diameter (DAPD) at the most constricted spinal level in supine and standing MRI were measured and compared. Clinical symptoms were assessed by duration of disease, claudication distance, visual analog scale (VAS) score of leg pain, and Chinese Oswestry Disability Index score of low back pain. The correlation between the parameters and clinical symptoms was analyzed by Pearson correlation coefficient (r).
Mean minimum DCSA and DAPD in the standing position were significantly smaller (both P < 0.01) than in the supine position. DCSA and DAPD in standing MRI and their changes had better correlation with the intermittent claudication distance and VAS score of leg pain than in the supine position. A more than 15 mm reduction of DSCA was observed in patients with shorter claudication distance and more severe VAS score of leg pain (both P < 0.01).
Dural sac size on MRI was reduced significantly from supine to standing position. Standing MRI and the changes of DCSA significantly correlated with claudication distance and VAS score of leg pain in patients with LSS. Therefore, standing MRI provides more radiologic information correlating with clinical symptoms in patients with LSS than supine MRI.
评估腰椎管狭窄症（LSS）患者从仰卧位到站立位时椎管大小的动态变化及其与临床症状的相关性。
前瞻性纳入 110 例 LSS 患者，分别行仰卧位（0°）和站立位（78°）磁共振成像（MRI）检查。测量并比较仰卧位和站立位 MRI 最狭窄节段椎管横截面积（DCSA）和椎管前后径（DAPD）。通过疾病持续时间、跛行距离、腿痛视觉模拟评分（VAS）和腰痛中国 Oswestry 残疾指数（CODI）评分评估临床症状。采用 Pearson 相关系数（r）分析参数与临床症状的相关性。
站立位最小 DCSA 和 DAPD 均值明显小于仰卧位（均 P < 0.01）。站立位 MRI 的 DCSA 和 DAPD 及其变化与间歇性跛行距离和腿痛 VAS 评分的相关性优于仰卧位。与跛行距离较短和腿痛 VAS 评分较重的患者相比，DCSA 减少超过 15 mm 的患者更多（均 P < 0.01）。
从仰卧位到站立位，MRI 上的椎管大小显著减小。站立位 MRI 和 DCSA 的变化与 LSS 患者的跛行距离和腿痛 VAS 评分显著相关。因此，与仰卧位 MRI 相比，站立位 MRI 为 LSS 患者提供了更多与临床症状相关的放射学信息。
