Qualitative Grading as a Tool in the Management of Multilevel Lumbar Spine Stenosis
Study DesignThis is a prospective study that was undertaken at a single centre and involved 80 consecutive patients diagnosed with lumbar spinal stenosis (LSS).PurposeThe aim of the study was to assess the efficacy of a qualitative grading system as seen on magnetic resonance imaging (MRI) as a tool...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Korean Spine Society
2017-04-01
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| Series: | Asian Spine Journal |
| Subjects: | |
| Online Access: | http://www.asianspinejournal.org/upload/pdf/asj-11-278.pdf |
| _version_ | 1819105856558465024 |
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| author | Shardul Madhav Soman Jimmy Chokshi Naitik Chhatrala Gulam Haider Tharadara Mukund Prabhakar |
| author_facet | Shardul Madhav Soman Jimmy Chokshi Naitik Chhatrala Gulam Haider Tharadara Mukund Prabhakar |
| author_sort | Shardul Madhav Soman |
| collection | DOAJ |
| description | Study DesignThis is a prospective study that was undertaken at a single centre and involved 80 consecutive patients diagnosed with lumbar spinal stenosis (LSS).PurposeThe aim of the study was to assess the efficacy of a qualitative grading system as seen on magnetic resonance imaging (MRI) as a tool in the management of multilevel LSS.Overview of LiteratureLSS diagnosis is clinical but is usually radiologically supplemented. However, there are often multilevel radiological findings with non-specific or atypical clinical features. We used a qualitative grading system to help in the decision-making process of the management of patients with multilevel LSS.Methods80 patients with LSS were treated with decompression and prospectively followed-up for a minimum of 12 months. All had failed conservative treatment. Qualitative grading of LSS severity was based on the dural sac in T2 weighted axial MRI images at all disc levels and was done from L1–2 to L5–S1 (n=400). Functional outcome was assessed using the Oswestry disability index (ODI).ResultsThe mean patient age was 56.6 years, with a gender ratio of 0.6:1. Forty patients had degenerative LSS and 40 had degenerative spondylolysthesis. A total of 178 levels were decompressed, the majority of which were L4–L5 (43.82%), followed by L5–S1 (41.57%). According to our qualitative grading system, grade D stenosis (53.93%) was decompressed most frequently, followed by grade C stenosis (41.57%). The average preoperative ODI score was 58.55%, which later reduced to 19.15%. Seventy percent of patients achieved excellent results, whereas 30% achieved good results.ConclusionsMorphological grading is a useful tool in decision making in surgery for multilevel LSS. Grade C and D stenosis should be decompressed, whereas A and B should not be, unless clinically justified. |
| first_indexed | 2024-12-22T02:28:54Z |
| format | Article |
| id | doaj.art-aa44237443cf4a71be49cd76de40d771 |
| institution | Directory Open Access Journal |
| issn | 1976-1902 1976-7846 |
| language | English |
| last_indexed | 2024-12-22T02:28:54Z |
| publishDate | 2017-04-01 |
| publisher | Korean Spine Society |
| record_format | Article |
| series | Asian Spine Journal |
| spelling | doaj.art-aa44237443cf4a71be49cd76de40d7712022-12-21T18:41:57ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462017-04-0111227828410.4184/asj.2017.11.2.278217Qualitative Grading as a Tool in the Management of Multilevel Lumbar Spine StenosisShardul Madhav Soman0Jimmy Chokshi1Naitik Chhatrala2Gulam Haider Tharadara3Mukund Prabhakar4Department of Orthopaedics, Government Spine Institute and Paraplegia Hospital, Ahmedabad, India.Department of Orthopaedics, Government Spine Institute and Paraplegia Hospital, Ahmedabad, India.Department of Orthopaedics, BJ Medical College and Civil Hospital, Ahmedabad, India.Department of Orthopaedics, BJ Medical College and Civil Hospital, Ahmedabad, India.Department of Orthopaedics, BJ Medical College and Civil Hospital, Ahmedabad, India.Study DesignThis is a prospective study that was undertaken at a single centre and involved 80 consecutive patients diagnosed with lumbar spinal stenosis (LSS).PurposeThe aim of the study was to assess the efficacy of a qualitative grading system as seen on magnetic resonance imaging (MRI) as a tool in the management of multilevel LSS.Overview of LiteratureLSS diagnosis is clinical but is usually radiologically supplemented. However, there are often multilevel radiological findings with non-specific or atypical clinical features. We used a qualitative grading system to help in the decision-making process of the management of patients with multilevel LSS.Methods80 patients with LSS were treated with decompression and prospectively followed-up for a minimum of 12 months. All had failed conservative treatment. Qualitative grading of LSS severity was based on the dural sac in T2 weighted axial MRI images at all disc levels and was done from L1–2 to L5–S1 (n=400). Functional outcome was assessed using the Oswestry disability index (ODI).ResultsThe mean patient age was 56.6 years, with a gender ratio of 0.6:1. Forty patients had degenerative LSS and 40 had degenerative spondylolysthesis. A total of 178 levels were decompressed, the majority of which were L4–L5 (43.82%), followed by L5–S1 (41.57%). According to our qualitative grading system, grade D stenosis (53.93%) was decompressed most frequently, followed by grade C stenosis (41.57%). The average preoperative ODI score was 58.55%, which later reduced to 19.15%. Seventy percent of patients achieved excellent results, whereas 30% achieved good results.ConclusionsMorphological grading is a useful tool in decision making in surgery for multilevel LSS. Grade C and D stenosis should be decompressed, whereas A and B should not be, unless clinically justified.http://www.asianspinejournal.org/upload/pdf/asj-11-278.pdfDecompressionLumbar spinal stenosisMultilevelGrading |
| spellingShingle | Shardul Madhav Soman Jimmy Chokshi Naitik Chhatrala Gulam Haider Tharadara Mukund Prabhakar Qualitative Grading as a Tool in the Management of Multilevel Lumbar Spine Stenosis Asian Spine Journal Decompression Lumbar spinal stenosis Multilevel Grading |
| title | Qualitative Grading as a Tool in the Management of Multilevel Lumbar Spine Stenosis |
| title_full | Qualitative Grading as a Tool in the Management of Multilevel Lumbar Spine Stenosis |
| title_fullStr | Qualitative Grading as a Tool in the Management of Multilevel Lumbar Spine Stenosis |
| title_full_unstemmed | Qualitative Grading as a Tool in the Management of Multilevel Lumbar Spine Stenosis |
| title_short | Qualitative Grading as a Tool in the Management of Multilevel Lumbar Spine Stenosis |
| title_sort | qualitative grading as a tool in the management of multilevel lumbar spine stenosis |
| topic | Decompression Lumbar spinal stenosis Multilevel Grading |
| url | http://www.asianspinejournal.org/upload/pdf/asj-11-278.pdf |
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