Radiologic Assessment of Lumbar Spinal Stenosis and its Clinical Correlation

Authors: B. Adamová 1,2;  M. Mechl 3;  T. Andrašinová 1;  J. Bednařík 1,2
Authors‘ workplace: Neurologická klinika LF MU a FN Brno 1;  CEITEC – Středoevropský technologický institut MU, Brno 2;  Radiologická klinika LF MU a FN Brno 3
Published in: Cesk Slov Neurol N 2015; 78/111(2): 139-147
Category: Review Article
doi: 10.14735/amcsnn2015130


Lumbar spinal stenosis is a clinical-radiological syndrome; a recent definition covers both the clinical manifestation and the anatomic abnormality (narrowing of the spinal canal). Magnetic resonance imaging is suggested as the most appropriate non-invasive test to confirm the presence of anatomic narrowing of the spinal canal or the presence of nerve root impingement in patients with clinical suspicion of lumbar spinal stenosis. Many numerical parameters describing the dimensions of spinal canal have been defined for more precise assessment of radiological images; correlation between these radiological parameters and clinical symptoms, however, is unsatisfactory. To improve the usefulness of radiological imaging in patients with lumbar spinal stenosis, it seems to be meaningful to take into account the dynamic aspect of lumbar spinal stenosis and to assess neural and vascular tissue impingement based on morphology of the dural sac and its content.

Key words:
lumbar spinal stenosis – magnetic resonance imaging – computed tomography –perimyelography – plain radiography – neurogenic claudication

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


1. Arnoldi CC, Brodsky AE, Cauchoix J, Crock HV, Dommis­se GF, Edgar MA et al. Lumbar spinal stenosis and nerve root entrapment syndromes. Definition and classification. Clin Orthop Relat Res 1976; 115: 4– 5.

2. Postacchini F. Management of lumbar spinal stenosis. J Bone Joint Surg Br 1996; 78(1): 154– 164.

3. Mamisch N, Brumann M, Hodler J, Held U, Brunner F, Steurer J et al. Radiologic criteria for the dia­gnosis of spinal stenosis: results of a Delphi survey. Radiology 2012; 264(1): 174– 179. doi: 10.1148/ radiol.12111930.

4. Epstein NE, Maldonado VC, Cusick JF. Symp­tomatic lumbar spinal stenosis. Surg Neurol 1998; 50(1): 3– 10.

5. Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF et al. An evidence‑based clinical guideline for the dia­gnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J 2013; 13(7): 734– 743. doi: 10.1016/ j.spinee.2012.11.059.

6. North American Spine Society (NASS). Evidence‑based clinical guidelines for multidisciplinary spine care: dia­gnosis and treatment of degenerative lumbar spinal stenosis (revised 2011) [online]. Available from URL: https:/ / Documents/ ResearchClinicalCare/ Guidelines/ LumbarStenosis.pdf.

7. Schönström N, Willén J. Imaging lumbar spinal stenosis. Radiol Clin North Am 2001; 39(1): 31– 53.

8. Maus TP. Imaging of spinal stenosis: neurogenic intermittent claudication and cervical spondylotic myelo­pathy. Radiol Clin North Am 2012; 50(4): 651– 679. doi: 10.1016/ j.rcl.2012.04.007.

9. Mechl M. Zobrazovací metody lumbální spinální stenózy. In: Mičánková Adamová B (ed). Lumbální spinální stenóza. Praha: Galén 2012: 95– 101.

10. Chaloupka R. Hodnocení nestability bederní páteře. In: Mičánková Adamová B (ed). Lumbální spinální stenóza. Praha: Galén 2012: 103– 105.

11. Chaloupka R, Vališ P, Motyčka J, Leznar M. Contribution to the radiological evaluation of stability in spondylolisthesis. Bulg J Orthop Trauma 1999; 35(1): 9– 15.

12. Eberhardt KE, Hollenbach HP, Tomandl B, Huk WJ. Three‑ dimensional MR myelography of the lumbar spine: comparative case study to X‑ray myelography. Eur Radiol 1997; 7(5): 737– 742.

13. Jinkins JR. Gd‑ DTPA enhanced MR of the lumbar spinal canal in patients with claudication. J Comput Assist Tomogr 1993; 17(4): 555– 562.

14. Eun SS, Lee HY, Lee SH, Kim KH, Liu WC. MRI versus CT for the dia­gnosis of lumbar spinal stenosis. J Neuroradiol 2012; 39(2): 104– 109. doi: 10.1016/ j.neurad.2011.02.008.

15. Steurer J, Roner S, Gnannt R, Hodler J. Quantitative radiologic criteria for the dia­gnosis of lumbar spinal stenosis: a systematic literature review. BMC Musculoskelet Disord 2011; 12: 175. doi: 10.1186/ 1471‑ 2474‑ 12‑ 175.

16. Fukusaki M, Kobayashi I, Hara T, Sumikawa K. Symp­toms of spinal stenosis do not improve after epidural steroid injection. Clin J Pain 1998; 14(2): 148– 151.

17. Koc Z, Ozcakir S, Sivrioglu K, Gurbet A, Kucukoglu S. Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis. Spine 2009; 34(10): 985– 989. doi: 10.1097/ BRS.0b013e31819c0a6b.

18. Tong HC, Carson JT, Haig AJ, Quint DJ, Phalke VR, Yamakawa KS et al. Magnetic resonance imaging of the lumbar spine in asymp­tomatic older adults. J Back Musculoskelet Rehabil 2006; 19: 67– 72.

19. Hamanishi C, Matukura N, Fujita M, Tomihara M, Tanaka S. Cross‑ sectional area of the stenotic lumbar dural tube measured from the transverse views of magnetic resonance imaging. J Spinal Disord 1994; 7(5): 388– 393.

20. Mariconda M, Fava R, Gatto A, Longo C, Milano C. Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis: a prospective comparative study with conservatively treated patients. J Spinal Disord Tech 2002; 15(1): 39– 46.

21. Laurencin CT, Lipson SJ, Senatus P, Botchwey E, Jones TR, Koris M et al. The stenosis ratio: a new tool for the dia­gnosis of degenerative spinal stenosis. Int J Surg Investig 1999; 1(2): 127– 131.

22. Haig AJ, Geisser ME, Tong HC, Yamakawa KS, Quint DJ,Hoff JT et al. Electromyographic and magnetic resonance imaging to predict lumbar stenosis, low‑ back pain, and no back symp­toms. J Bone Joint Surg Am 2007; 89(2): 358– 366.

23. Verbiest H. The significance and principles of computerized axial tomography in idiopathic developmental stenosis of the bony lumbar vertebral canal. Spine 1979; 4(4): 369– 378.

24. Adamová B, Bednařík J, Šmardová L, Moravcová E,Chvátalová N, Prokeš B et al. Asociace mezi cervikální a lumbální stenózou páteřního kanálu. Cesk Slov Neurol N 2000; 63/ 96(5): 261– 267.

25. Jönsson B, Annertz M, Sjöberg C, Strömqvist B. A prospective and consecutive study of surgical­­ly treated lumbar spinal stenosis. Part I: Clinical features related to radiographic findings. Spine 1997; 22(24): 2932– 2937.

26. Herno A, Airaksinen O, Saari T. Computed tomography after laminectomy for lumbar spinal stenosis. Patients‘ pain patterns, walking capacity, and subjective dis­ability had no correlation with computed tomography findings. Spine 1994; 19(17): 1975– 1978.

27. Verbiest H. Chapter 16. Neurogenic intermittent claudication in cases with absolute and relative stenosis of the lumbar vertebral canal (ASLC and RSLC), in cases with narrow lumbar intervertebral foramina, and in cases with both entities. Clin Neurosurg 1973; 20: 204– 214.

28. Barz T, Melloh M, Staub LP, Lord SJ, Lange J, Röder CP et al. Nerve root sedimentation sign: evaluation of a new radiological sign in lumbar spinal stenosis. Spine 2010; 35(8): 892– 897. doi: 10.1097/ BRS.0b013e3181c7cf4b.

29. Barz T, Staub LP, Melloh M, Hamann G, Lord SJ, Chatfield MD et al. Clinical validity of the nerve root sedimentation sign in patients with suspected lumbar spinal stenosis. Spine J 2014; 14(4): 667– 674. doi: 10.1016/ j.spinee.2013.06.105.

30. Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine 2010; 35(21): 1919– 1924. doi: 10.1097/ BRS.0b013e3181d359bd.

31. Kent DL, Haynor DR, Larson EB, Deyo RA. Dia­gnosis of lumbar spinal stenosis in adults: a metaanalysis of the accuracy of CT, MR, and myelography. AJR Am J Roentgenol 1992; 158(5): 1135– 1144.

32. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW.Abnormal magnetic‑ resonance scans of the lumbar spine in asymp­tomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990; 72(3): 403– 408.

33. Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, Deyo RA. The longitudinal assessment of imaging and Disability of the Back (LAIDBack) Study: baseline data. Spine 2001; 26(10): 1158– 1166.

34. Zeifang F, Schiltenwolf M, Abel R, Moradi B. Gait analysis does not correlate with clinical and MR imaging parameters in patients with symp­tomatic lumbar spinal stenosis. BMC Musculoskelet Disord 2008; 9: 89. doi: 10.1186/ 1471‑ 2474‑ 9‑ 89.

35. Sirvanci M, Bhatia M, Ganiyusufoglu KA, Duran C,Tezer M, Ozturk C et al. Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging. Eur Spine J 2008; 17(5): 679– 685. doi: 10.1007/ s00586‑ 008‑ 0646‑ 5.

36. Ogikubo O, Forsberg L, Hansson T. The relationship between the cross‑ sectional area of the cauda equina and the preoperative symp­toms in central lumbar spinal stenosis. Spine 2007; 32(13): 1423– 1428.

37. Egli D, Hausmann O, Schmid M, Boos N, Dietz V, Curt A.Lumbar spinal stenosis: assessment of cauda equina involvement by electrophysiological recordings. J Neurol 2007; 254(6): 741– 750.

38. Haig AJ, Tong HC, Yamakawa KS, Quint DJ, Hoff JT,Chiodo A et al. Spinal stenosis, back pain, or no symp­toms at all? A masked study comparing radiologic and electrodia­gnostic dia­gnoses to the clinical impression. Arch Phys Med Rehabil 2006; 87(7): 897– 903.

39. Aalto TJ, Malmivaara A, Kovacs F, Herno A, Alen M, Salmi L et al. Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis: systematic review. Spine 2006; 31(18): E648– E663.

40. Hurri H, Slätis P, Soini J, Tallroth K, Alaranta H, Laine Tet al. Lumbar spinal stenosis: assessment of long‑term outcome 12 years after operative and conservative treatment. J Spinal Disord 1998; 11(2): 110– 115.

41. Adamova B, Vohanka S, Dusek L, Jarkovsky J, Chaloupka R, Bednarik J. Outcomes and their predictors in lumbar spinal stenosis: a 12‑year follow‑up. Eur Spine J2015; 24: 369–380. doi: 10.1007/ s00586‑ 014‑ 3411‑ y.

42. Simotas AC, Dorey FJ, Hansraj KK, Cammisa F jr. Non­operative treatment for lumbar spinal stenosis. Clinical and outcome results and a 3‑year survivorship analysis. Spine 2000; 25(2): 197– 203.

43. Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F. Lumbar spinal stenosis: conservative or surgical management? A prospective 10‑year study. Spine 2000; 25(11): 1424– 1435.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 2

2015 Issue 2

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account