Clinical Symptoms Of Lumbar Spinal Stenosis Associated With The Parameters On Radiological Images

Objective:This study aimed to investigate the association between the clinical symptoms of lumbar spinal stenosis(LSS)and parameters using magnetic resonance imaging(MRI)data.Methods:We retrospectively reviewed patients who visited our spine surgery clinic at Zhongda Hospital,Southeast University from december 2014 to september 2016 and were diagnosed as LSS.All patients underwent MRI of the L-spine and we measured the vertebral body cross-sectional Area(VCA),spinal canal cross-sectional area(SCA),dural sac cross-sectional area(DSA),vertebral’s transverse diameter(VTD),vrtebral’s sagital(VS),canal’s transverse diameter(CTD),canal’s sagital(CS),ligamentum flavum cross-sectional area(LFA),ligamentum flavum thickness(LFT),lateral recess’s sagital(LRS),lateral recess’s angle(LRA),foraminal height(FHT),superior foraminal width(SFW),foraminal cross-sectional area(FCA)and nerve root’s cross-sectional area(NRCA)at L3-4、L4-5 and L5-S1 level on MRI.Clinical outcomes were investigated using the patient-assessed quantitative measurement of visual analog scale(VAS)and subjective disability was assessed by the Oswestry Disability Index(ODI).Additionally,subjective walking distance(SWD)was also collected from electronic medical records.Lumbar MRI imaging parameters were collected from the control group at the same time.We compare all imaging parameters within and between groups by using t test,while comparing the imaging parameters with the basic data of patients and clinical symptoms by using Spearman rank correlation test and Pearson correlation test.Results:In this study,a total of 108 patients diagnosed as lumbar spinal stenosis patients met the inclusion and exclusion criteria.There were 60 males and 48 females,aged 45～82 years old,average 67.78 years old.While 88 cases without lumbar spinal stenosis patients as control group,48 cases were male and 40 were female,aged 35～61 years old,average 42 years old.In the patient group,there was no significant difference between male and female patients(p>0.05),while male’s average height was significant more than female’s(P<0.05).The MRI imaging parameters in patient group and the control group between male and female had no significant difference(p>0.05),there are different degrees of difference in clinical symptoms between male and female in the patient group.The DSA/SCA in male and female patients are negatively associated with low back pain VAS significantly(P<0.01).There was no significant association between the ODI or lower limb pain VAS in male and female patients and imaging parameters(P>0.05).Both male and female patients of SWD are significantly associated with SFW(P<0.05).Conclusion:The main clinical symptom in LSS patients is neurogenic intermittent claudication.There were many MRI radiological parameters influencing the SWD,in which the SWD was significantly correlated with the SFW and the degree of stenosis of intervertebral foramen.Larger DSA/SCA values are associated with lower ODI values in LSS patients.There are no association between MRI radiological parameters and low limb pain,ODI values.As perts of lumbar canal stenosis,the central lumbar canal,lateral recess and intervertebral foramen play important roles in the pathogenesis of lumbar spinal stenosis.At the same time of decompression operation,we cannot neglect the intraoperative exploration and complete decompression of intervertebral foramen.