Abstract
Introduction
Several parameters exist for assessment of lumbar spinal stenosis (LSS) but none has shown to be an absolute criteria for defining the condition. Moreover these parameters lack clinical correlation to help physicians to decide on the plan of management.
Aim
To assess the clinical relevance of the qualitative grading described for LSS and to formulate a protocol for management of these group of patients.
Materials and Methods
A prospective study was undertaken between the period of 2014–15 using the qualitative grading based on T2 weighted MRI1 to assess the clinical outcome of 83 patients with clinical signs and symptoms suggestive of lumbar spinal stenosis at a single level to divide them into 7 morphological categories A 1–4,B, C, and D. Patients with more than two level stenosis, congenital stenosis, instability, having undergone previous surgery, other neurological disease were excluded. The diagnosis and the qualitative grading was done by a Senior surgeon not part of the study. Irrespective of the grade every patient underwent a minimum three month period of conservative management after which depending on the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for pain was grouped into success or failure and the failed patients were advised for decompression surgery in form of laminectomy at the involved level. These patients were further grouped into success or failure after a period of three months after surgery. A 15 point decrease in ODI and a VAS scale of less than 5 on admission into the study was considered as a success.
Results
Out of the 83 patients there were 57 failure in conservative group while out of these 50 were operated of which only 10 did not match the success criteria, while the other 7 either refused surgery or were lost to follow up. As per the grading in types A1 and 2 only 2 patients out of 17 failed conservative trial while in all the other grades from A3 to D there was a gradual decline in success of conservative trial. In patients with grades C and D all patients failed conservative trial and required surgery. In comparison for grades A3 to D operative outcome had a significantly better outcomes as measured by the Chi-square test with p-value < 0.05 considered significant.
Conclusion
We conclude that the qualitative grading can be used as a tool for decision making in LSS. Patients with grade A4, B, C and D should be advised for an early surgery to achieve a good functional outcome as there was a high incidence of failure of conservative management in these patients. While in patients with grade A1 to A3 a conservative management is to be recommended.
Reference
Schizas C, Theumann N, Burn A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine 2010;35(21):1919–1924