Reducing surgical levels by paraspinal mapping and diffusion tensor imaging techniques in lumbar spinal stenosis.
BACKGROUND
Correlating symptoms and physical examination findings with surgical levels based on common imaging results is not reliable. In patients who have no concordance between radiological and clinical symptoms, the surgical levels determined by conventional magnetic resonance imaging (MRI) and neurogenic examination (NE) may lead to a more extensive surgery and significant complications. We aimed to confirm that whether the use of diffusion tensor imaging (DTI) and paraspinal mapping (PM) techniques can further prevent the occurrence of false positives with conventional MRI, distinguish which are clinically relevant from levels of cauda equina and/or nerve root lesions based on MRI, and determine and reduce the decompression levels of lumbar spinal stenosis than MRI + NE, while ensuring or improving surgical outcomes.


METHODS
We compared the data between patients who underwent MRI + (PM or DTI) and patients who underwent conventional MRI + NE to determine levels of decompression for the treatment of lumbar spinal stenosis. Outcome measures were assessed at 2 weeks, 3 months, 6 months, and 12 months postoperatively.


RESULTS
One hundred fourteen patients (59 in the control group, 54 in the experimental group) underwent decompression. The levels of decompression determined by MRI + (PM or DTI) in the experimental group were significantly less than that determined by MRI + NE in the control group (p = 0.000). The surgical time, blood loss, and surgical transfusion were significantly less in the experimental group (p = 0.001, p = 0.011, p = 0.001, respectively). There were no differences in improvement of the visual analog scale back and leg pain (VAS-BP, VAS-LP) scores and Oswestry Disability Index (ODI) scores at 2 weeks, 3 months, 6 months, and 12 months after operation between the experimental and control groups.


CONCLUSIONS
MRI + (PM or DTI) showed clear benefits in determining decompression levels of lumbar spinal stenosis than MRI + NE. In patients with lumbar spinal stenosis, the use of PM and DTI techniques reduces decompression levels and increases safety and benefits of surgery.
Department of Orthopaedic, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China.
Hua-Biao
HB
Chen
Department of Radiology, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China.
Qi
Q
Wan
Department of Electromyography, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China.
Qi-Feng
QF
Xu
Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China.
Yi
Y
Chen
Department of Orthopaedic, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China. 18620941118@163.com.|Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China. 18620941118@163.com.
Bo
B
Bai
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002420:Cauda Equina / Q000000981:diagnostic imaging; D019299:Decompression, Surgical / Q000379:methods; D056324:Diffusion Tensor Imaging; D004185:Disability Evaluation; D004576:Electromyography / Q000379:methods; D005189:False Positive Reactions; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D011237:Predictive Value of Tests; D011843:Radiculopathy / Q000175:diagnosis / Q000601:surgery; D016037:Single-Blind Method; D013130:Spinal Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Diffuse tensor imagining; Lumbar spinal stenosis; Oswestry Disability Index; Paraspinal mapping; Visual analog pain scale