A recent study 1 published in the last legs of 2019 set out to find the correlation between clinical symptoms and MRI findings in patients who are suspected to be suffering from lumbar spinal canal stenosis.
What was the Context?
Lumbar spinal stenosis (LSS) is the most common sign that a patient over the age of 65 will need a spinal surgery. What is LSS? It is a condition that shows decrease in the available space for the vascular and neural components of the lumbar spinal cord.
Within clinical practice, symptomatic LSS comes with different symptoms. This includes: buttock pain, bilateral or unilateral neurological disorder, and pain in the lower extremities.
LSS manifests usually because of less space present for neural and vascular structures of the lumbar spine. The definition of LSS has two aspects: structural abnormalities and clinical manifestations. Both are a result of certain physical abnormalities.
Previous studies have shown that clinical symptoms showing mild to moderate lumbar LSS might exist in less than half of patients.
So in order to define destructive LSS, it’s important that clinical symptoms match up with the imaging results. This is the reason why using clinical findings along with radiological evaluation through magnetic resonance imaging (MRI) is seen as proper standard in diagnosing LSS.
Numerous clinical criteria and imaging are available for the diagnosis of LSS. But despite the availability, coming up for the right diagnosis is a challenging part for radiologists and clinicians.
Therefore, this study aims to assess and understand the relation between clinical symptoms and MRI findings in groups of symptomatic and asymptomatic patients having suspected LSS.
What was the Methodology?
Using a case-control study, there are two groups of 100 symptomatic and asymptomatic individuals involved. Their ages range from 20 to 84 years old.
Both the groups have suspected lumbar spinal canal stenosis. They were all referred to the imaging unit for lumbosacral MRI. Within the study, patients’ clinical symptoms and radiological parameters in MRI were recorded. Afterwards, the researchers evaluated the results of the correlation between clinical symptoms and MRI findings.
What Were the Results?
Throughout the duration of the case-control study, 100 patients in the case group with signs and symptoms of LSS were evaluated.
100 patients in the control group who underwent lumbar MRI were also evaluated throughout the study period. Age ranges of the case group were between 21 to 84 years old. While the age range for the control group was 20 to 84 years old.
Table 1 in the study showed the prevalence of clinical symptoms in patients who did or didn’t have LSS symptoms.
Table 2 shows the quantitative and qualitative radiological features in case and control groups.
What Does This Mean?
The most common clinical manifestations of patients in both case and control groups involved:
- Mechanical low back pain
- Radicular pain
- Gluteal pain
There were also no significant relationships between most clinical symptoms with each of the radiological indices separately. The highest significant correlation was observed between radiological indices and neurogenic claudication.
What Was Concluded?
Based on the results of the quantitative criteria of MRI imaging findings, the central spinal canal cross-section and lateral recesses cross-section had the highest specificity and sensitivity for LSS diagnosis in asymptomatic and symptomatic patients with suspected LSS.
The strongest observed correlation? It was between neurogenic claudication and LSS diagnostic radiological markers.