Background & Aims
Central lumbar spinal stenosis (CLSS) is one of the most prevalent disease affecting elderly population that leads to the loss of function and the disability to realise basic activities of daily living [1]. A lot of clinical scores have been used to quantify the severity of CLSS. Some scales like Oswestry Disability Index (ODI) point on the disability associated with the disease while other scales like Numerical rating scale (NRS) and Euro Quality of Life – 5D (EQ-5D) mainly consider the pain. Primarily CLSS is a clinico-radiological diagnosis therefore magnetic resonance imaging (MRI) plays a key role in diagnosis and treatment. However, the correlation between clinical scales and MRI parameters is not very clear. The aim of the study was to find out the correlation between NRS, ODI, EQ-5D and quantitative MRI parameters.
Methods
Patients with clinical and radiological characteristics of CLSS completed clinical questionnaires NRS, ODI and EQ-5D. Lumbosacral MRIs performed and quantitative parameters anteroposterior diameter of spinal canal (APDS), cross-sectional area dural sac (CSAD), lateral recess depth and angle (LRD, LRA) were measured at the maximum stenotic level. The clinical and radiological parameters were then statistically analysed.
Results
219 patients (median age 69.7 years, female 56.8%) with degenerative CLSS were enrolled to this study. The CSAD had a moderate correlation with NRS and ODI (p<0.05,0.6>r ? 0.2). LRA showed a moderate negative correlation with NRS, ODI and EQ-5D (p<0.05,0.6>r ? 0.2). LRD had a moderate negative correlation with ODI and NRS score (p<0.05,0.6>r ? 0.2). LRA had a moderate correlation with the EQ-5D and ODI (p<0.05,0.7>r ? 0.3). The CSAD had a moderate negative correlation with EQ-5D (r = ?0.383, p = 0.000).
Conclusions
Negative correlation was recognised for most of the quantitative MRI parameters when compared to commonly used NRS, ODI and EQ-5D. For that reason, poor MRI’s don’t necessarily demonstrate poor clinical scores in CLSS. Quantitative MRI parameters should have supplementary role, and clinicians should avoid relying on them in CLSS management.
References
[1] Arbit E, Pannullo S. Lumbar stenosis: a clinical review. Clin Orthop Relat Res 2001;(384):137-43.