Jørn Aaen1,2,3, Ivar Magne Austevoll4,5,6, Christian Hellum7,6, Kjersti Storheim8,6, Tor Åge Myklebust9,6, Hasan Banitalebi10,11,6, Masoud Anvar12,6, Jens Ivar Brox13,6, Clemens Weber6,14,15, Tore Solberg6,16,17, Oliver Grundnes6,18, Helena Brisby6,19,20, Kari Indrekvam4,5,6, Erland Hermansen21,4,5,6. 1. Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway. Jorn.Aaen@helse-mr.no. 2. Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway. Jorn.Aaen@helse-mr.no. 3. Department of Orthopaedics, Stavanger University Hospital, Stavanger, Norway. Jorn.Aaen@helse-mr.no. 4. Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway. 5. Department of Clinical Medicine, University of Bergen, Bergen, Norway. 6. Department of Orthopaedics, Stavanger University Hospital, Stavanger, Norway. 7. Division of Orthopedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway. 8. Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway. 9. Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway. 10. Department of Diagnostic Imaging, Akershus University Hospital, Akershus, Norway. 11. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 12. Unilabs Radiology, Oslo, Norway. 13. Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway. 14. Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway. 15. Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway. 16. Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway. 17. Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway. 18. Department of Orthopedics, Akershus University Hospital, Akershus, Norway. 19. Dept of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden. 20. Dept. of Orthopaedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 21. Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.
Abstract
PURPOSE: The aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain. METHODS: The NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight. RESULTS: The percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm2) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (≥ 15°) 11.9%, degeneration of multifidus muscle (2-4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score. CONCLUSION: In this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings. TRIAL REGISTRATION: www. CLINICALTRIALS: gov identifier: NCT02007083, registered December 2013.
PURPOSE: The aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain. METHODS: The NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight. RESULTS: The percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm2) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (≥ 15°) 11.9%, degeneration of multifidus muscle (2-4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score. CONCLUSION: In this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings. TRIAL REGISTRATION: www. CLINICALTRIALS: gov identifier: NCT02007083, registered December 2013.
Authors: James N Weinstein; Tor D Tosteson; Jon D Lurie; Anna N A Tosteson; Emily Blood; Brett Hanscom; Harry Herkowitz; Frank Cammisa; Todd Albert; Scott D Boden; Alan Hilibrand; Harley Goldberg; Sigurd Berven; Howard An Journal: N Engl J Med Date: 2008-02-21 Impact factor: 91.245
Authors: William C Watters; Jamie Baisden; Thomas J Gilbert; Scott Kreiner; Daniel K Resnick; Christopher M Bono; Gary Ghiselli; Michael H Heggeness; Daniel J Mazanec; Conor O'Neill; Charles A Reitman; William O Shaffer; Jeffrey T Summers; John F Toton Journal: Spine J Date: 2007-12-21 Impact factor: 4.166
Authors: Jørn Aaen; Hasan Banitalebi; Ivar Magne Austevoll; Christian Hellum; Kjersti Storheim; Tor Åge Myklebust; Masoud Anvar; Clemens Weber; Tore Solberg; Oliver Grundnes; Helena Brisby; Kari Indrekvam; Erland Hermansen Journal: Eur Spine J Date: 2022-08-05 Impact factor: 2.721