Jørn Aaen1,2, Hasan Banitalebi3,4, Ivar Magne Austevoll5,6, Christian Hellum7, Kjersti Storheim8, Tor Åge Myklebust9, Masoud Anvar10, Clemens Weber11,12, Tore Solberg13,14, Oliver Grundnes15, Helena Brisby16,17, Kari Indrekvam5,6, Erland Hermansen18,5,6. 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 Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway. 4. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 5. Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway. 6. Department of Clinical Medicine, University of Bergen, Bergen, Norway. 7. Division of Orthopedic Surgery, Oslo University Hospital Ullevaal, 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. Unilabs Radiology, Oslo, Norway. 11. Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway. 12. Dept. of Quality and Health Technology, University of Stavanger, Stavanger, Norway. 13. Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway. 14. Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway. 15. Department of Orthopedics, Akershus University Hospital, Lørenskog, Norway. 16. Dept of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden. 17. Dept. of Orthopaedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 18. Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.
Abstract
PURPOSE: To investigate potential associations between preoperative MRI findings and patient reported outcome measures (PROMs) after surgery for lumbar spinal stenosis (LSS). METHODS: The NORDSTEN trial included 437 patients. We investigated the association between preoperative MRI findings such as morphological grade of stenosis (Schizas grade), quantitative grade of stenosis (dural sac cross-sectional area), disc degeneration (Pfirrmann score), facet joint tropism and fatty infiltration of the multifidus muscle, and improvement in patient reported outcome measures (PROMs) 2 years after surgery. We dichotomized each radiological parameter into a moderate or severe category. PROMs i.e., Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) and Numeric rating scale (NRS) for back and leg pain were collected before surgery and at 2 year follow-up. In the primary analysis, we investigated the association between MRI findings and ODI score (dichotomized to ≥ 30% improvement or not). In the secondary analysis, we investigated the association between MRI findings and the mean improvement on the ODI-, ZCQ- and NRS scores. We used multivariable regression models adjusted for patients' gender, age, smoking status and BMI. RESULTS: The primary analysis showed that severe disc degeneration (Pfirrmann score 4-5) was significantly associated with less chance of achieving a 30% improvement on the ODI score (OR 0.54, 95% CI 0.34, 0.88). In the secondary analysis, we detected no clinical relevant associations. CONCLUSION: Severe disc degeneration preoperatively suggest lesser chance of achieving 30% improvement in ODI score after surgery for LSS. Other preoperative MRI findings were not associated with patient reported outcome.
PURPOSE: To investigate potential associations between preoperative MRI findings and patient reported outcome measures (PROMs) after surgery for lumbar spinal stenosis (LSS). METHODS: The NORDSTEN trial included 437 patients. We investigated the association between preoperative MRI findings such as morphological grade of stenosis (Schizas grade), quantitative grade of stenosis (dural sac cross-sectional area), disc degeneration (Pfirrmann score), facet joint tropism and fatty infiltration of the multifidus muscle, and improvement in patient reported outcome measures (PROMs) 2 years after surgery. We dichotomized each radiological parameter into a moderate or severe category. PROMs i.e., Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) and Numeric rating scale (NRS) for back and leg pain were collected before surgery and at 2 year follow-up. In the primary analysis, we investigated the association between MRI findings and ODI score (dichotomized to ≥ 30% improvement or not). In the secondary analysis, we investigated the association between MRI findings and the mean improvement on the ODI-, ZCQ- and NRS scores. We used multivariable regression models adjusted for patients' gender, age, smoking status and BMI. RESULTS: The primary analysis showed that severe disc degeneration (Pfirrmann score 4-5) was significantly associated with less chance of achieving a 30% improvement on the ODI score (OR 0.54, 95% CI 0.34, 0.88). In the secondary analysis, we detected no clinical relevant associations. CONCLUSION: Severe disc degeneration preoperatively suggest lesser chance of achieving 30% improvement in ODI score after surgery for LSS. Other preoperative MRI findings were not associated with patient reported outcome.
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Authors: J N Katz; S J Lipson; G W Brick; L J Grobler; J N Weinstein; A H Fossel; R A Lew; M H Liang Journal: Spine (Phila Pa 1976) Date: 1995-05-15 Impact factor: 3.468