title: Lumbar Spinal Canal Stenosis Classification Criteria: A New Tool.
abstract: METHODS
  Case-control study.
  
  
  OBJECTIVE
  To design a new tool for classifying lumbar spinal canal stenosis (CLSCS).
  
  
  BACKGROUND
  Grading of patients with lumbar spinal canal stenosis (LSCS) is controversial.
  
  
  METHODS
  The Oswestry disability index (ODI) and the neurogenic claudication outcome score (NCOS) were recorded. Four parameters, which indicate the severity of LSCS disease, including Hufschmidt-grade, grading of magnetic resonance imaging, self-paced walking test, and stenosis ratio (SR) were employed. For the SR, quartile analysis was applied for classifying LSCS and the Hufschmidt-grade was modified into a 4-grade score. An initial score was assigned to each metric based on the severity of LSCS. Using the inverse-variance weighting method, the relative weights of these domains and their categories were determined. The score for all of the cases was obtained based on their weight by summing up the points of the four variables. Quartile analysis was used and a CLSCS score was proposed. Finally, intra- and interobserver reliability, and validity were assessed.
  
  
  RESULTS
  A total of 357 patients were studied. The final CLSCS score for each case ranged from 4 to 16.5. Based on the quartile analysis, using the new criteria set, the CLSCS score was divided into four categories: CLSCS<7 (grade 0); 7≤CLSCS<10 (grade 1); 10≤CLSCS<13 (grade 2); and 13≤CLSCS≤16.5 (grade 3). The kappa values of for the CLSCS score indicated a perfect agreement. The CLSCS was correlated with the ODI and NCOS. All patients with grade 3 CLSCS were observed in the surgical group.
  
  
  CONCLUSIONS
  The CLSCS score can be helpful for classifying LSCS patients and in the decision-making process.
authors.affiliation: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Parisa
authors.initials: P
authors.lastname: Azimi
authors.affiliation: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hassan Reza
authors.initials: HR
authors.lastname: Mohammadi
authors.affiliation: Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.affiliation: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Sohrab
authors.initials: S
authors.lastname: Shahzadi
authors.affiliation: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Shirzad
authors.initials: S
authors.lastname: Azhari
keywords: Classification; Classifying lumbar spinal canal stenosis; Lumbar spinal canal stenosis; New tool