Abstract
Introduction
The relationship between clinical disability and various parameters such as degree of constriction of dural sac, radiological pelvic parameters, facet joint orientation in patients with degenerative LCS has not been clearly defined.
Materials and Methods
A total of 50 patients with LCS were selected prospectively and divided into two groups (20 patients responding to conservative therapy and 30 requiring surgery) and compared with 16 controls. Patients were clinically evaluated by Oswestry disability index (ODI), SF-12, and neurogenic claudication outcome score (NCOS). All patients underwent anteroposterior, lateral dynamic radiographs of lumbar spine, and whole spine standing lateral radiograph. The spinopelvic parameters measured were spinosacral angle, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. Dural sac cross-sectional area, lateral recess angle and height, and facet joint orientation were assessed in MRI.
Results
Between conservative and operated group, the mean ODI score (55.5 vs. 62.99, p = 0.014) and NCOS (37.7 vs. 29.47, p = 0.06) were significantly different. Dural sac area significantly differed (p < 0.001) between control (113.97 ± 57.58), conservative (47.57 ± 24.77), and operated groups (20.66 ± 14.49). NCOS had significant positive correlation with dural sac area (r = 0.296, p = 0.037) than ODI. In patients with degenerative spondylolisthesis, there was a significant sagittal orientation of facet joints, high pelvic incidence (58.79 vs. 50.57, p = 0.047), and an increased pelvic tilt (18.99 vs. 11.25, p = 0.045).
Conclusion
Degree of dural sac stenosis corresponds to clinical disability and NCOS is a better indicator of dural sac compression than ODI score. LCS patients with sagittal facet orientation, high pelvic incidence, and high pelvic tilt develop spondylolisthesis.
None declared