Evaluation of parameter changes in lateral lumbosacral radiography of patients with lumbar spinal stenosis in MRI

Abstract

Background

Magnetic resonance imaging (MRI) is the gold standard for evaluating lumbar spinal stenosis (LSS); however, its high cost and potential overuse raise concerns. Although plain radiographs are more accessible and cost-effective, there is currently no established radiographic criterion for the diagnosis of LSS.

Purpose

To investigate in 100 patients the effect of LSS on objective parameters reflected on radiographs and to adapt existing radiographic indices for the diagnosis of LSS.

Material and Methods

Between September 2017 and May 2018, a retrospective evaluation was performed on 100 patients who underwent lumbosacral MRI and lateral lumbosacral radiography for back and/or leg pain. LSS was confirmed in 50 patients, and various angles, measurements, and ratios were calculated on the radiographs of these patients.

Results

Pelvic incidence (PI) was significantly higher in the LSS group (P = 0.029). Foraminal width (FW) and pedicle width (PW) were significantly lower at all levels in patients with spinal stenosis (P <0.001 and P <0.005). Sagittal vertebral body width (SBW):PW ratio was significantly higher at all levels in the LSS group (P <0.005). Receiver operating characteristic (ROC) analysis was performed for the parameters showing significant differences between the LSS and control groups. Cutoff values were calculated for each significant parameter and level, and among them, PW, FW, and SBW:PW showed relatively high sensitivity, specificity and accuracy.

Conclusion

PW, FW, and the SBW/PW ratio demonstrated high sensitivity and specificity in the diagnosis of LSS. These parameters may be useful for screening purposes; however, they are not sufficient on their own for clinical or surgical decision-making.