title: Decision-making process in patients with lumbar spinal canal stenosis.
abstract: BACKGROUND
  The aim of this study was to develop a strategy to determine a sound methodology for decision-making in lumbar spinal canal stenosis (LSCS).
  
  
  METHODS
  This was a retrospective study of patients with LSCS to determine the rationale for those who underwent surgery and those who received conservative treatment. All case records were assessed to extract information on the morphology grade and dural sac cross-sectional surface area (DSCA) on MRI. Patients' functionality and satisfaction were examined as outcome measures in order to understand factors that were associated with benefit from either treatment strategy.
  
  
  RESULTS
  In all 357 patients, case records were reviewed. The mean age of patients was 57.5 (SD=10.9) years. Of these, 176 patients underwent surgery. Post-treatment satisfaction was found in a large portion of the surgical group (93.2%) whereas this was 84.5% for those who received conservative treatment. Most patients (86.4%) who underwent surgery were identified as having grade C and grade D stenosis, while those who received conservative treatment were identified as having grade A and grade B stenosis (P<0.01). Overall satisfaction with surgery was found to be higher among patients with grade D stenosis (95%). Satisfaction by cross-sectional surface area did not show a consistent pattern. However, those with a cross-sectional surface area less than 100 mm2 benefited more from surgery. According to the findings, a decision matrix was proposed.
  
  
  CONCLUSIONS
  The findings suggest that the morphological grade and the DSCA jointly are useful parameters for helping clinicians to make clinically sound decisions in LSCS patients.
authors: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran - parisa.azimi@gmail.com.
authors: Parisa
authors: P
authors: Azimi
authors: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Hassan R
authors: HR
authors: Mohammadi
authors: Cleveland Clinic Foundation, Department of Neurosurgery, Cleveland, OH, USA.
authors: Edward C
authors: EC
authors: Benzel
authors: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Shorab
authors: S
authors: Shahzadi
authors: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Shirzad
authors: S
authors: Azhari
authors: Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.
authors: Ali
authors: A
authors: Montazeri
mesh_terms: D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making / Q000379:methods*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*