Department of Orthospine, Sir Ganga Ram Hospital, New Delhi, India.
Department of Neurosurgery, Nanoori Suwon Hospital, Gyeonggi-do, Korea, Suwon, Korea.
J Neurol Surg A Cent Eur Neurosurg. 2020 Sep;81(5):387-391. doi: 10.1055/s-0039-1698393. Epub 2020 Feb 27.
Although spinal canal narrowing is thought to be the defining feature for the clinical diagnosis of lumbar canal stenosis, the degree of spinal canal stenosis necessary to elicit neurologic symptoms is not clear. Several studies have been performed to detect an association between a narrow spinal canal and clinical symptoms. Through our prospective study, we compared the radiologic criteria with the clinical criteria using the Oswestry Disability Index (ODI) and assessed how they correlate.
We used the qualitative grading (morphological classification system on magnetic resonance imaging [MRI]) system, dural sac cross-sectional area (DSCA), and sedimentation sign on MRI images and compared them with the Self-Paced Walking Ability (Self-Paced Walking Test) and ODI of the patients in the study. The systems were applied to 85 patients divided into three groups: group A: 43 patients with neurogenic claudication and able to walk < 30 minutes; group B: 11 patients with neurogenic claudication and able to walk > 30 minutes; and group C: 31 patients with simple back pain and no signs of neurologic claudication.
The mean ODI was 21.19 in group C, 46.50 in group B, and 61.95 in group A. The difference was statistically significant. The mean DSCA was 164.42 mm in group C, 49.94 mm in group B, and 35.07 mm in group A. The difference was statistically significant. The sedimentation sign was negative in 96.8% patients in group C, 54.5% patients in group B, and 32.6% patients in group A. The difference was statistically significant. Group C had 9.3% patients in morphology grade A3, 51.6% in grade A2, and 38.7% patients in grade A1. Group B had 63.6% patients in grade C, 18.2% patients in grade B, 9.1% in grade A4, and 9.1% in grade A3. Group A had 18.6% patients in grade D, 39.5% in grade C, 27.9% in grade B, 11.6% in grade A4, and 2.3% in grade A3. The mean DSCA of group C was significantly different from group A and group B, but the difference of the mean DSCA between group A and group B was not statistically significant. The relationship of ODI to DSCA, ODI to sedimentation sign, and ODI to morphological grading for group C and group A was not statistically significant. The relationship of morphological grading to DSCA was statistically significant for all three groups.
DSCA, morphological grading, and sedimentation sign are good to excellent radiologic indicators differentiating patients with simple back pain from those with lumbar spinal stenosis. Clinically, ODI is an excellent indicator of the severity of stenosis. But ODI statistically has no significant correlation to any of these radiologic parameters.
虽然椎管狭窄被认为是腰椎管狭窄症临床诊断的决定性特征，但引起神经症状所需的椎管狭窄程度尚不清楚。已经进行了几项研究来检测狭窄的椎管与临床症状之间的关联。通过我们的前瞻性研究，我们使用 Oswestry 残疾指数（ODI）比较了影像学标准和临床标准，并评估了它们的相关性。
我们使用了定性分级（磁共振成像[MRI]上的形态分类系统）系统、硬脑膜囊横截面积（DSCA）和 MRI 图像上的沉降征，并将其与研究中患者的自我 paced 行走能力（自我 paced 行走测试）和 ODI 进行了比较。该系统应用于 85 名患者，分为三组：A 组：43 名有神经源性跛行且行走时间<30 分钟的患者；B 组：11 名有神经源性跛行且行走时间>30 分钟的患者；C 组：31 名仅有背痛且无神经源性跛行迹象的患者。
C 组的平均 ODI 为 21.19，B 组为 46.50，A 组为 61.95。差异具有统计学意义。C 组的平均 DSCA 为 164.42mm，B 组为 49.94mm，A 组为 35.07mm。差异具有统计学意义。C 组 96.8%的患者沉降征为阴性，B 组为 54.5%，A 组为 32.6%。差异具有统计学意义。C 组形态学分级 A3 患者占 9.3%，A2 患者占 51.6%，A1 患者占 38.7%。B 组 63.6%的患者为 C 级，18.2%的患者为 B 级，9.1%的患者为 A4 级，9.1%的患者为 A3 级。A 组 18.6%的患者为 D 级，39.5%的患者为 C 级，27.9%的患者为 B 级，11.6%的患者为 A4 级，2.3%的患者为 A3 级。C 组的平均 DSCA 与 A 组和 B 组有显著差异，但 A 组和 B 组之间的平均 DSCA 差异无统计学意义。C 组和 A 组的 ODI 与 DSCA、ODI 与沉降征、ODI 与形态学分级之间的关系无统计学意义。C 组和 A 组的形态学分级与 DSCA 之间的关系有统计学意义。
DSCA、形态学分级和沉降征是区分单纯腰痛和腰椎管狭窄症患者的良好至优秀的影像学指标。临床上，ODI 是评估狭窄严重程度的优秀指标。但 ODI 与这些影像学参数均无统计学显著相关性。
