Does magnetic resonance imaging morphology correlate with preoperative neurological status in operatively treated lumbar canal stenosis? A retrospective study.

Abstract

Retrospective observational study. To determine whether objective neurological deficits in lumbar canal stenosis (LCS) correlate with the commonly used radio-logical grading systems. LCS is primarily a clinical diagnosis determined based on symptoms of neurological claudication and lower back pain, which is confirmed using radiological evidence. However, the current radiological measures of LCS do not often correlate with the clinical severity of the syndrome, particularly in terms of sensory, motor, and bladder/bowel dysfunction. Preoperative clinical and imaging data of 100 consecutive cases of operated LCS were reviewed to determine symptom severity (using the Zurich Claudication Questionnaire [ZCQ]) and neurological dysfunction. Four radiological scores based on axial magnetic resonance imaging-Schizas's, Lee's, Miskin and Mandell's (M&M), and Menon's-were computed for each patient. The association between the severity of neurological dysfunction and radiological classification was assessed. All patients were graded as having moderate or severe grade LCS based on the ZCQ score. The Schizas score was significantly associated with motor (p=0.029) and sensory (p=0.034) deficits, and the M&M score was significantly associated with only motor deficits (p=0.012). The Lee and Menon's classifications did not show significant associations with any neurological dysfunction (Lee: motor: p=0.258, sensory: p=0.615; Menon's score: motor: p=0.1368, sensory: p=0.668). Surgical decisions in LCS should not be based on imaging findings, but rather on the clinical severity of symptoms and presence of neurological dysfunction.