title: Correlation between disability and MRI findings in lumbar spinal stenosis: a prospective study of 109 patients operated on by decompression.
abstract: OBJECTIVE
  MRI is the modality of choice when diagnosing spinal stenosis but it also shows that stenosis is prevalent in asymptomatic subjects over 60. The relationship between preoperative health-related quality of life, functional status, leg and back pain, and the objectively measured dural sac area in single and multilevel stenosis is unknown. We assessed this relationship in a prospective study.
  
  
  METHODS
  The cohort included 109 consecutive patients with central spinal stenosis operated on with decompressive laminectomy or laminotomy. Preoperatively, all patients completed the questionnaires for EQ-5D, SF-36, Oswestry disability index (ODI), estimated walking distance and leg and back pain (VAS). The cross-sectional area of the dural sac was measured at relevant disc levels in mm², and spondylolisthesis was measured in mm. For comparison, the area of the most narrow level, the number of levels with dural sac area < 70 mm², and spondylolisthesis were studied.
  
  
  RESULTS
  Before surgery, patients with central spinal stenosis had low HRLQoL and functional status, and high pain levels. Patients with multilevel stenosis had better general health (p = 0.04) and less leg and back pain despite having smaller dural sac area than patients with single-level stenosis. There was a poor correlation between walking distance, ODI, the SF-36, EQ-5D, and leg and back pain levels on the one hand and dural sac area on the other. Women more often had multilevel spinal stenosis (p = 0.05) and spondylolisthesis (p < 0.001). Spondylolisthetic patients more often had small dural sac area (p = 0.04) and multilevel stenosis (p = 0.06).
  
  
  CONCLUSIONS
  Our findings indicate that HRQoL, function, and pain measured preoperatively correlate with morphological changes on MRI to a limited extent.
authors: Department of Orthopedics, Clincal Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden. freyr.gauti.sigmundsson@ltblekinge.se
authors: Freyr G
authors: FG
authors: Sigmundsson
authors: Xiao P
authors: XP
authors: Kang
authors: Bo
authors: B
authors: Jönsson
authors: Björn
authors: B
authors: Strömqvist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D019299:Decompression, Surgical / Q000379:methods; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D011788:Quality of Life; D013130:Spinal Stenosis / Q000473:pathology* / Q000523:psychology / Q000601:surgery; D013168:Spondylolisthesis / Q000473:pathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016138:Walking