title: Comparison of Surgeon Rating of Severity of Stenosis Using Magnetic Resonance Imaging, Dural Cross-Sectional Area, and Functional Outcome Scores.
abstract: OBJECTIVE
  To determine the relationship between the severity of stenosis graded using both surgeons' visual assessment of spinal stenosis as well as measurement of dural cross-sectional area on magnetic resonance imaging (MRI), with the patient's disability.
  
  
  METHODS
  Seven fellowship-trained spine surgeons reviewed MRI studies retrospectively of 30 symptomatic consecutive patients with lumbar stenosis and graded stenosis in the central canal, the lateral recess, and the foramen at T12-L1 to L5-S1 as none, mild, moderate, or severe. Dural cross-sectional area was measured at each level from T12-L1 to L5-S1. All patients completed the questionnaires for Oswestry Disability Index (ODI), Short Form 36 (SF-36), and recorded Visual Analog Scale scores for leg and back pain, and symptom severity scale of the Zurich claudication questionnaire.
  
  
  RESULTS
  There was positive correlation between the right leg pain Visual Analog Scale score and the mean surgeon grades for central and lateral recess stenosis at L4-L5 and lateral recess stenosis at L5-S1. Except for a positive correlation between role physical score and surgeon grade for lateral recess stenosis at L5-S1, we found no correlation between the surgeons' grading of stenosis at any level with the ODI or SF-36. We found no correlation between the dural cross-sectional area with the ODI or SF-36. We did not find any correlation between the Zurich symptom severity scale and surgeons' grading of stenosis at any level.
  
  
  CONCLUSIONS
  Although surgeons rely on visual assessment of the severity of stenosis while making surgical decisions, we found that objective and subjective imaging parameters to grade severity of stenosis did not consistently indicate the patient's disability level.
authors: Syracuse Veterans Affairs Medical Center, Syracuse, New York, USA.
authors: Satyajit V
authors: SV
authors: Marawar
authors: Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA.
authors: Nathaniel R
authors: NR
authors: Ordway
authors: Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA.
authors: Ian A
authors: IA
authors: Madom
authors: Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA.
authors: Richard A
authors: RA
authors: Tallarico
authors: Division of Spine Surgery, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA.
authors: Mark
authors: M
authors: Palumbo
authors: Carolina Pines Regional Medical Center, Hartsville, South Carolina, USA.
authors: Umesh
authors: U
authors: Metkar
authors: Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, New York, USA.
authors: Dongliang
authors: D
authors: Wang
authors: Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, New York, USA.
authors: Danning
authors: D
authors: Huang
authors: Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA. Electronic address: lavellew@upstate.edu.
authors: William F
authors: WF
authors: Lavelle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D066231:Surgeons / Q000523:psychology*; D011795:Surveys and Questionnaires; D064232:Visual Analog Scale
keywords: Dural cross-sectional area; Lumbar spinal stenosis; Oswestry Disability Index (ODI); Radiologic grading; Short Form 36 (SF-36); Visual Analog Scale (VAS); Zurich claudication questionnaire