Splettstößer A, Khan MF, Zimmermann B, Vogl TJ, Ackermann H, Middendorp M, Maataoui A. Correlation of lumbar lateral recess stenosis in magnetic resonance imaging and clinical symptoms. World J Radiol 2017; 9(5): 223-229 [PMID: 28634513 DOI: 10.4329/wjr.v9.i5.223]
Corresponding Author of This Article
Adel Maataoui, MD, Institute for Diagnostic and Interventional Radiology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany. adel.maataoui@gmx.de
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Basic Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
M Fawad Khan, Bernd Zimmermann, Thomas J Vogl, Adel Maataoui, Institute for Diagnostic and Interventional Radiology, Goethe University, 60590 Frankfurt/Main, Germany
Hanns Ackermann, Institute of Biostatistics and Mathematical Modeling, Goethe University, 60590 Frankfurt/Main, Germany
Marcus Middendorp, Department of Nuclear Medicine, Goethe University, 60590 Frankfurt/Main, Germany
Author contributions: Middendorp M and Maataoui A contributed equally to this work; Maataoui A and Vogl TJ supervised the project; Splettstößer A, Middendorp M, and Maataoui A wrote the main paper; all authors were involved in the study design, data analysis, and discussion of the results at all stages.
Institutional review board statement: The study inclusive of patient information and consent form was reviewed and approved by the ethics committee of the State Authorisation Association for Medical Issues of Hessen, Germany (FF 48/2014). Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to examination by written consent.
Conflict-of-interest statement: All authors ensure that there are no conflicts of interest.
Data sharing statement: Consent was not obtained but the presented data are anonymized and risk of identification is very low. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Adel Maataoui, MD, Institute for Diagnostic and Interventional Radiology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany. adel.maataoui@gmx.de
Telephone: +49-69-63015534 Fax: +49-69-63014222
Received: October 7, 2016 Peer-review started: October 14, 2016 First decision: November 11, 2016 Revised: February 22, 2017 Accepted: March 16, 2017 Article in press: March 17, 2017 Published online: May 28, 2017 Processing time: 224 Days and 4.6 Hours
Abstract
AIM
To assess the correlation of lateral recess stenosis (LRS) of lumbar segments L4/5 and L5/S1 and the Oswestry Disability Index (ODI).
METHODS
Nine hundred and twenty-seven patients with history of low back pain were included in this uncontrolled study. On magnetic resonance images (MRI) the lateral recesses (LR) at lumbar levels L4/5 and L5/S1 were evaluated and each nerve root was classified into a 4-point grading scale (Grade 0-3) as normal, not deviated, deviated or compressed. Patient symptoms and disability were assessed using ODI. The Spearman’s rank correlation coefficient was used for statistical analysis (P < 0.05).
RESULTS
Approximately half of the LR revealed stenosis (grade 1-3; 52% at level L4/5 and 42% at level L5/S1) with 2.2% and 1.9% respectively reveal a nerve root compression. The ODI score ranged from 0%-91.11% with an arithmetic mean of 34.06% ± 16.89%. We observed a very weak statistically significant positive correlation between ODI and LRS at lumbar levels L4/5 and L5/S1, each bilaterally (L4/5 left: rho < 0.105, P < 0.01; L4/5 right: rho < 0.111, P < 0.01; L5/S1 left: rho 0.128, P < 0.01; L5/S1 right: rho < 0.157, P < 0.001).
CONCLUSION
Although MRI is the standard imaging tool for diagnosing lumbar spinal stenosis, this study showed only a weak correlation of LRS on MRI and clinical findings. This can be attributed to a number of reasons outlined in this study, underlining that imaging findings alone are not sufficient to establish a reliable diagnosis for patients with LRS.
Core tip: In the presented study lateral recesses of nearly 1000 patients with low back pain were evaluated on magnetic resonance imaging (MRI) and correlated with patient symptoms. Though MRI is the method of choice for diagnosing lumbar spinal stenosis, we revealed only a very weak correlation of lateral recess stenosis (LRS) and patient symptoms. This can be attributed to numerous reasons outlined in this study, underlining that imaging findings alone are not sufficient for an adequate diagnostic approach of patients with LRS.
