DOES

FUNCTIONAL
EVALUATION
AND
MAGNETIC
RESONANCE
IMAGING
FINDING IN A CASE OF
LUMBAR CANAL STENOSIS

? CORELATE
A STUDY OF 50 CASES

AMEER WASEEM HASAN

INTRODUCTION
First used by H. Verbiest,
“stenosis of the vertebral
canal” is < 10 mm
narrowing on myelography.
HISTORY
• Neurogenic claudication
• Pain  by walking or standing erect
• Usually bilateral, often assymetrical

• Bending forward and sitting

 symptoms
• Wide base gait
• Sense of weakness and instability

• Simian posture
• Shopping cart sign
• Unimpressive examination
METHODS
INCLUSION CRITERIA
 Age > 30 yrs
 Clinical diagnosis of LCS (Neurogenic
claudication, radicular pain, .. )
 Central Stenosis

EXCLUSION CRITERIA
 Lateral recess, foraminal stenosis
 Vascular claudication  DM, smoking, alcohol
consumption, B12 def.  Instability
 50 patients diagnosed to have lumbar
EVALUATION canal stenosis were evaluated..
o Symptoms
o Physical Examination : SLR, Neur., ..
o Oswestry disability index
o MRI

1. AP and transverse diameter of the

dural SAC
2. Dural SAC cross sectional area in
axial section
3. Foraminal height in axial section
 AP diameter

Transverse diameter

Foramen Height

Cross sectional area

At the level of the disc

 AP diameter

Transverse diameter

Cross sectional area

At the level of the pedicle

 AP height

Foramen Height

Transverse diameter

Cross sectional area

Between the disc and pedicle levels

Based on the measurements, the patients
were divided into...

Absolute LCS :
AP diameter <10 mm and/or
Dural sac CSA <75 mm2

Relative LCS:
AP diameter:10-13 mm and/or
Dural sac CSA: 76 mm2 to 100 mm2.

No LCS:
AP diameter: > 13 mm and/or
Dural sac CSA: >100 mm2.
The Oswestry Disability Index ODI

• Simple questionnaire used to quantify the

disability from back pain.
• It consists of 10 sections on various aspects
• Each section has a Max score of 5 points
• Then the result is classifies into:
Mild (0-20%)
Moderate (21-40%)
Severe (41 – 60 %)
Crippled (61 – 80%)
Bedridden (81-100%)
RESULTS

Symptoms

Tingling numbness 64%

Weakness 40%

Neurogenic Claudication 100%

Low back pain 70%

EXAMINATION FINDING

PERCENTAGE

Extension catch 84%

Abscent Ankle Jerk 16%

Motor Deficit 20%

Sensory Deficit 32%

Positive SLR 4%
ODI SCORE

PERCENTAGE

Bedridden (80-100%)
0%

Crippled (60-80%) 16%

Severe (40-60%) 44%

Moderate (20-4-%) 22%

Minimun (0-20%) 18%

 MRI CO-RELATION
4%
22%
No LCS 6%
4%

8%
14%
Relative LCS 8%
6%

4%
8%
Absolute LCS 8%
8%

There is no association between functional severity and radiological findings in LCS.

DISCUSSION
Results of other studies ..

Sirvanci et al (2008)
• No correlation was found between ODI score and dural sac
CSA.
•No correlation between subdivisions of the degree of the
canal stenosis and ODI.

Lohman et al (1995)
• The number of levels with absolute or relative spinal stenosis
did not correlate to the clinical symptoms.
•There was no correlation between ODI scores and degree of
narrowing in patients with and without spondylolisthesis.
DISCUSSION
Results of other studies ..

Lim Young et al (2017)

• Dural sac CSA (< 111 mm2) has 80% sensitivity and specificity
for central LCS.

Hudges et al (2015)
• Proposed a new method that measures a “coefficient of
stenosis” that was highly correlated with ODI scores.
• But this method was subjective and difficult to apply routinely.
REFERENCES
1. Hussain, N., Patil, N. D., Shakya, A., & Saindane, K. P. (2017). Does
functional evaluation and magnetic resonance imaging finding in a case
of lumbar canal stenosis co-relate: a study of 50 cases. International
Journal of Research in Orthopaedics, 3(4), 751. doi:10.18203/issn.2455-
4510.intjresorthop20172543

2. Lim, Y. S., Mun, J., Seo, M. S., Sang, B., Bang, Y., Kang, K. N., . . . Kim, Y.
U. (2017). Dural sac area is a more sensitive parameter for evaluating
lumbar spinal stenosis than spinal canal area. Medicine, 96(49).

3. Hughes A, Makirov SK, Osadchiy V. Measuring spinal canal size in

lumbar spinal stenosis: description of method and preliminary
results. International Journal of Spine Surgery. 2015;9:3.
doi:10.14444/2008.
THANK YOU.