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Spine (Phila Pa 1976). 2018 Mar 1;43(5):348-355. doi: 10.1097/BRS.0000000000001301.

Preoperative MRI in Patients With Intermittent Neurogenic Claudication: Relevance for Diagnosis and Prognosis.

Author information

1
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
2
Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands.
3
Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands.

Abstract

STUDY DESIGN:

We studied baseline magnetic resonance images of 155 patients with intermittent neurogenic claudication and lumbar spinal stenosis (LSS). Magnetic resonance imaging (MRI) and patient data were gathered from participants of a randomized trial.

OBJECTIVE:

It is believed that the narrowness of the lumbar spinal canal correlates to the severity of complaints and that it may be a good predictor of clinical outcome if treated. However, this hypothesis has never been (prospectively) tested.

SUMMARY OF BACKGROUND DATA:

MRI is an important tool to confirm the diagnosis of LSS as a cause for intermittent neurogenic claudication.

METHODS:

Three raters were asked to evaluate the magnetic resonance images (Schizas scale). Symptom severities at baseline and 1-year follow-up were quantified. The radiological scores were correlated with clinical baseline and outcome scores to assess diagnostic and prognostic value of MRI findings at baseline.

RESULTS:

There was good agreement on the clinically relevant level of LSS (kappa range 0.57-0.64). MRI assessment of grading of compression (kappa 0.33-0.46) did not correlate with baseline MRDQ nor with outcome based on postoperative change in MRDQ (P = 0.61). However, both absence of epidural fat and presence of tortuous caudal nerves on magnetic resonance images (kappa 0.53-0.72 and 0.67-0.70) in patients with LSS were relatively good predictors for satisfactory recovery after surgery (P = 0.03 and P < 0.01).

CONCLUSION:

The grading of compression on the preoperative MRI is neither ambiguous nor correlating to severity of clinical condition. It does, furthermore, not have the ability to predict the outcome after 1 year if surgically treated.

LEVEL OF EVIDENCE:

2.

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