Is There an Association Between Radiological Severity of Lumbar Spinal Stenosis and Disability, Pain, or Surgical Outcome?: A Multicenter Observational Study.
METHODS
Observational multicenter study.


OBJECTIVE
To evaluate if the severity of lumbar spinal stenosis (LSS) on magnetic resonance imaging (MRI) correlates with preoperative disability, pain, or surgical outcomes.


BACKGROUND
Surgeons use the morphological appearance of LSS on MRI for clinical decision making. However, the associations between radiological severity of LSS and disability, pain, or surgical outcomes remain unclear.


METHODS
Evaluation of severity of LSS on preoperative MRI according to the Schizas morphological classification. Patient and treatment data were retrieved from the Norwegian Registry for Spine Surgery. Preopertaive outcome measures were Oswestry disability index (ODI) and numeric rating scale (NRS) scores for back and leg pain. Postopertive outcome measures were ODI and NRS scores for back and leg pain at 1 year, changes in ODI and NRS scores after treatment, duration of surgery, length of hospital stay, and perioperative complications.


RESULTS
Of 202 patients included, 7 were found to have mild stenosis, 38 had moderate stenosis, 108 had severe stenosis, and 49 had extreme stenosis. The radiological severity of LSS was not linked to preoperative ODI (P = 0.089), NRS back pain (P = 0.273), or NRS leg pain (P = 0.282) scores. There were no differences in ODI (P = 0.933), NRS back pain (P = 0.652), or NRS leg pain (P = 0.912) scores after 1 year. The radiological severity of stenosis was not associated with change in ODI (P = 0.494), NRS back pain (P = 0.235), NRS leg pain (P = 0.790), duration of surgery (P = 0.661), length of hospital stay (P = 0.739), or perioperative complication rates (P = 0.467).


CONCLUSIONS
Among patients who underwent decompressive surgery for LSS, radiological severity of stenosis was not associated with preoperative disability and pain, or clinical outcomes 1 year after surgery. In this patient group, the radiological severity of LSS has no clear clinical correlation and should therefore not be overemphasized in clinical decision making.


METHODS
2.
*Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway†Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway‡National Advisory Unit on Spinal Surgery, St. Olavs University Hospital, Trondheim, Norway§Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway¶Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden||Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway#Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway**Norwegian Centre of Competence in Deep Brain Stimulation for Movement Disorders, St. Olavs University Hospital, Trondheim, Norway††National Competence Center for Ultrasound and Image Guided Therapy, St. Olavs University Hospital, Trondheim, Norway.
Clemens
C
Weber
Charalampis
C
Giannadakis
Vidar
V
Rao
Asgeir S
AS
Jakola
Ulf
U
Nerland
Øystein P
ØP
Nygaard
Tore K
TK
Solberg
Sasha
S
Gulati
Ole
O
Solheim
D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology*; D019299:Decompression, Surgical; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009664:Norway; D019637:Orthopedic Procedures; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011859:Radiography; D012042:Registries; D012720:Severity of Illness Index; D013130:Spinal Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome