The importance of morphological and clinical clas­sifications of lumbar spine stenosis in the preoperative plan­ning

Authors: D. Bludovský;  D. Štěpánek;  M. Kulle;  M. Choc;  V. Přibáň
Authors‘ workplace: Neurochirurgická klinika LF UK a FN Plzeň
Published in: Cesk Slov Neurol N 2018; 81(1): 45-50
Category: Original Paper


The aim of our study was to investigate the relations between subjective difficulties, clinical findings and the MRI in patients who have been operated for symptomatic lumbar spinal stenosis (LSS), and the possibility of using these relations for surgical treatment decision.

Patients operated for LSS in 2009–2010 were included in the study. Subjective difficulties were assessed using the Oswestry Disability Index (ODI), the clinical symptoms with the modified Neurological Impairment Score for Lumbar Spinal Stenosis (mNIS-LSS). We measured the spinal canal area, dural sac area, and nerve root sedimentation classification on MRI. We tested the relations between these categories using the correlation analysis at significance level p < 0.05.

61 patients with a median age of 67 were included. Median ODI value was 48. Overall, we evaluated 162 spinal segments. Correlation coefficients for ODI, mNIS-LSS and graphical findings were less than 0.5. Correlation coefficients greater than 0.5 were between all the MRI measurement methods.

In the group of patients indicated for surgery for symptomatic LSS, we did not found a statistically significant correlation between subjective patient difficulties, neurological findings and MRI. Statistically significant correlations are among the selected LSS measurement techniques for MRI. For common use, the easiest of them is nerve root sedimentation classification according to Schizas.

Key words:
lumbar spinal stenosis – lumbar spine – magnetic resonance imagining– surgical treatment

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.

Chinese summary - 摘要





研究包括2009-2010年为LSS手术的患者。 使用Oswestry残疾指数(ODI)评估主观困难,使用修改的腰椎管狭窄症的神经学损伤评分(mNIS-LSS)评估临床症状。 我们在MRI上测量的椎管面积,硬膜囊面积和神经根聚集程度。 我们用显着性水平p <0.05的相关分析检验了这些类别之间的关系。


包括61名中位年龄为67岁的患者。中位ODI值为48.总的来说,我们评估了162个脊髓节段。 ODI,mNIS-LSS和图表发现的相关系数均小于0.5。 所有MRI测量方法之间的相关系数大于0.5。


在有症状LSS手术指征的患者组中,我们没有发现患者主观困难,神经系统症状和MRI之间显著的统计学相关性。所选MRI的LSS测量技术在统计学上有着显著的相关性。 根据Schizas,最常用的是神经根聚集程度。


腰椎椎管狭窄 - 腰椎 - 磁共振成像 - 手术治疗


1. North American Spine Society. Evidence-based clinical guideline for the dia­gnosis and treatment of degenerative lumbal spinal stenosis (revised 2011). Available from URL: https:/ / Documents/ ResearchClinicalCare/ Guidelines/ LumbarStenosis.pdf

2. Adamová B, Mech M, Andrašinová T et al. Radiologické hodnocení lumbální spinální stenózy a jeho klinická korelace. Cesk Slov Neurol N 2015; 78/ 111(2): 139– 147. doi: 10.14735/ amcsn­n2015130.

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

4. Adamová B, Voháňka S, Dušek L et al. Outcomes and their predictors in lumbar spinal stenosis: a 12-year fol­low-up. Eur Spine J 2015; 24(2): 369– 380. doi: 10.1007/ s00586-014-3411-y.

5. Schizas C, Theumann N, Burn A 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.

6. 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): 1432– 1438. doi: 10.1097/ BRS.0b013e318060a5f5.

7. Sirvanci M, Bhatia M, Ganiyusufoglu KA 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.

8. Zeifang F, Schiltenwolf M, Abel R et al. 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.

9. Fairbank JC, Pynsent PF. The Oswestry disability index. Spine 2000; 25(22): 2940– 2952.

10. Mičánková Adamová B, Bendařík J, Chaloupka R et al. Lumbální spinální stenóza. 1. vyd. Praha: Galén 2012.

11. Voháňka S, Adamová B. Lumbální spinální stenóza. In: Adamčová H et al. Neurologie 2003 –  Trendy v medicíně. Praha: Triton 2003: 160– 180.

12. Schizas C, Kulik G. Decision-mak­­ing in lumbar spinal stenosis: A survey on the influence of the morphology of the dural sac. J Bone Joint Surg Br 2012; 94(1): 98– 101. doi: 10.1302/ 0301-620X.94B1.27420.

13. Surgimap. Nemaris Inc. Available from URL: https:/ /

14. Hamanishi C, Matukura N, Fujita M et al. 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.

15. Statistica. TIBCO Software Inc. Available from URL: https:/ /

16. Henderson L, Kulik G, Richarme D et al. Is spinal stenosis as­ses­sment dependent on slice orientation? A magnetic resonance imag­­ing study. Eur Spine J 2012; 21 (Suppl 6): S760– S764. doi: 10.1007/ s00586-011-1857-8.

17. Tong HC, Carson JT, Haig AJ et al. Magnetic resonance imag­­ing of the lumbar spine in asymp­tomatic older adults. J Back Musculoskelet Rehabil 2006; 19: 67– 92.

18. Barz T, Mel­loh M, Staub LP 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.

19. Burgstal­ler JM, Schüf­fler PJ, Buhmann JM et al. Is there an as­sociation between pain and magnetic resonance imag­­ing parameters in patients with lumbar spinal stenosis? Spine 2016; 41(17): E1053– E1062. doi: 10.1097/ BRS.0000000000001544.

20. Weber C, Gian­nadakis C, Rao V et al. Is there an as­sociation between radiological severity of lumbar spinal stenosis and disability, pain, or surgical outcome? A multicenter observational study. Spine 2016; 41(12): E78– E83. doi: 10.1097/ BRS.0000000000001166.

21. Kalíková E, Adamová B, Keřkovský M et al. Klinický přínos radiologických parametrů u lumbální spinální stenózy. Cesk Slov Neurol N 2017; 80/ 113(4): 400– 407. doi: 10.14735/ amcsn­n2017400.

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