European Spine Journal

, Volume 17, Issue 5, pp 686–690 | Cite as

The diagnostic value of a treadmill test in predicting lumbar spinal stenosis

  • Thomas Barz
  • Markus Melloh
  • Lukas StaubEmail author
  • Christoph Roeder
  • Jörn Lange
  • Franz-Georg Smiszek
  • Jean-Claude Theis
  • Harry R. Merk
Original Article


Lumbar spinal stenosis is a frequent indication for spinal surgery. The predictive quality of treadmill testing and MRI for diagnostic verification is not yet clearly defined. Aim of the current study was to assess correlations between treadmill testing and MRI findings in the lumbar spine. Twenty-five patients with lumbar spinal stenosis were prospectively examined. Treadmill tests were performed and the area of the dural sac and neuroforamina was examined with MRI for the narrowest spinal segment. VAS and ODI were used for clinical assessment. The median age of the patients was 67 years. In the narrowest spinal segment the median area of the dural sac was 91 mm2. The median ODI was 66 per cent. The median walking distance in the treadmill test was 70 m. The distance reached in the treadmill test correlated with the area of the dural sac (Spearman’s ρ = 0.53) and ODI (ρ = −0.51), but not with the area of the neuroforamina and VAS. The distance reached in the treadmill test predicts the grade of stenosis in MRI but has a limited diagnostic importance for the level of clinical symptoms in lumbar spinal stenosis.


Spinal stenosis Treadmill test MRI Spine Spinal canal 


  1. 1.
    Amundsen T, Weber H, Lilleas F, Nordal HJ, Abdelnoor M, Magnaes B (1995) Lumbar spinal stenosis. Clinical and radiologic features. Spine 20(10):1178–1186PubMedCrossRefGoogle Scholar
  2. 2.
    Bolender NF, Schonstrom NS, Spengler DM (1985) Role of computed tomography and myelography in the diagnosis of central spinal stenosis. J Bone Joint Surg Am 67(2):240–246PubMedGoogle Scholar
  3. 3.
    Deen HG Jr, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM (1995) Measurement of exercise tolerance on the treadmill in patients with symptomatic lumbar spinal stenosis: a useful indicator of functional status and surgical outcome. J Neurosurg 83(1):27–30PubMedGoogle Scholar
  4. 4.
    Deen HG Jr, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM (2000) Test-retest reproducibility of the exercise treadmill examination in lumbar spinal stenosis. Mayo Clin Proc 75(10):1002–1007PubMedCrossRefGoogle Scholar
  5. 5.
    Deen HG, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM (1998) Use of the exercise treadmill to measure baseline functional status and surgical outcome in patients with severe lumbar spinal stenosis. Spine 23(2):244–248PubMedCrossRefGoogle Scholar
  6. 6.
    Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66(8):271–273PubMedGoogle Scholar
  7. 7.
    Gouzien P, Cazalbou C, Boyer B, Darodes de Tailly P, Guenec Y, Senecail B (1990) Measurements of the normal lumbar spinal canal by computed tomography. Segmental study of L3-L4 and L4-L5 related to the height of the subject. Surg Radiol Anat 12(2):143–148PubMedCrossRefGoogle Scholar
  8. 8.
    Hamanashi C, Matukura N, Fujita M, Tomihara M, Tanaka S (1994) Cross-sectional area of the stenotic lumbar dural tube measured from the transverse views of magnetic resonance imaging. J Spinal Disord 7(5):388–393Google Scholar
  9. 9.
    Herno A, Airaksinen O, Saari T (1994) Computed tomography after laminectomy for lumbar spinal stenosis. Patients’ pain patterns, walking capacity, and subjective disability had no correlation with computed tomography findings. Spine 19(17):1975–1978PubMedCrossRefGoogle Scholar
  10. 10.
    Hida S, Naito M, Kubo M (2003) Intraoperative measurements of nerve root blood flow during discectomy for lumbar disc herniation. Spine 28(1):85–90PubMedCrossRefGoogle Scholar
  11. 11.
    Hildebrandt J, Müller G, Pfingsten M (2005) Lendenwirbelsäule: Ursachen, Diagnostik und Therapie von Rückenschmerzen. 1. Elsevier, Urban und Fischer, AuflageGoogle Scholar
  12. 12.
    Katz JN (1995) Lumbar spinal fusion. Surgical rates, costs, and complications. Spine 20(24 Suppl):78S–83SPubMedCrossRefGoogle Scholar
  13. 13.
    Katz JN, Dalgas M, Stucki G, Katz NP, Bayley J, Fossel AH, Chang LC, Lipson SJ (1995) Degenerative lumbar spinal stenosis. Diagnostic value of the history and physical examination. Arthritis Rheum 38(9):1236–1241PubMedCrossRefGoogle Scholar
  14. 14.
    Katz JN, Dalgas M, Stucki G, Lipson SJ (1994) Diagnosis of lumbar spinal stenosis. Rheum Dis Clin North Am 20(2):471–483PubMedGoogle Scholar
  15. 15.
    Kent DL, Haynor DR, Larson EB, Deyo RA (1992) Diagnosis of lumbar spinal stenosis in adults: a metaanalysis of the accuracy of CT, MR, and myelography. AJR Am J Roentgenol 158(5):1135–1144PubMedGoogle Scholar
  16. 16.
    Kobayashi S, Uchida K, Takeno K, Baba H, Suzuki Y, Hayakawa K, Yoshizawa H (2006) Imaging of cauda equina edema in lumbar canal stenosis by using gadolinium-enhanced MR imaging: experimental constriction injury. AJNR Am J Neuroradiol 27(2):346–353PubMedGoogle Scholar
  17. 17.
    Moon ES, Kim HS, Park JO, Shin DE, Ha JW, Shim DJ, Kwak YH, Lee KI (2005) Comparison of the predictive value of myelography, computed tomography and MRI on the treadmill test in lumbar spinal stenosis. Yonsei Med J 46(6):806–811PubMedCrossRefGoogle Scholar
  18. 18.
    Ogikubo O, Forsberg L, Hansson T (2007) The relationship between the cross-sectional area of the cauda equina and the preoperative symptoms in central lumbar spinal stenosis. Spine 32(13):1423–1428PubMedCrossRefGoogle Scholar
  19. 19.
    Olmarker K, Holm S, Rydevik B (1990) Importance of compression onset rate for the degree of impairment of impulse propagation in experimental compression injury of the porcine cauda equina. Spine 15(5):416–419PubMedCrossRefGoogle Scholar
  20. 20.
    Pratt RK, Fairbank JC, Virr A (2002) The reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Spine 27(1):84–91PubMedCrossRefGoogle Scholar
  21. 21.
    Schonstrom N, Hansson T (1988) Pressure changes following constriction of the cauda equina. An experimental study in situ. Spine 13(4):385–388PubMedCrossRefGoogle Scholar
  22. 22.
    Schonstrom NS, Bolender NF, Spengler DM (1985) The pathomorphology of spinal stenosis as seen on CT scans of the lumbar spine. Spine 10(9):806–811PubMedCrossRefGoogle Scholar
  23. 23.
    Speciale AC, Pietrobon R, Urban CW, Richardson WJ, Helms CA, Major N, Enterline D, Hey L, Haglund M, Turner DA (2002) Observer variability in assessing lumbar spinal stenosis severity on magnetic resonance imaging and its relation to cross-sectional spinal canal area. Spine 27(10):1082–1086PubMedCrossRefGoogle Scholar
  24. 24.
    Takahashi K, Kagechika K, Takino T, Matsui T, Miyazaki T, Shima I (1995) Changes in epidural pressure during walking in patients with lumbar spinal stenosis. Spine 20(24):2746–2749PubMedCrossRefGoogle Scholar
  25. 25.
    Takahashi K, Olmarker K, Holm S, Porter RW, Rydevik B (1993) Double-level cauda equina compression: an experimental study with continuous monitoring of intraneural blood flow in the porcine cauda equina. J Orthop Res 11(1):104–109PubMedCrossRefGoogle Scholar
  26. 26.
    Willen J, Danielson B, Gaulitz A, Niklason T, Schonstrom N, Hansson T (1997) Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication. Spine 22(24):2968–2976PubMedCrossRefGoogle Scholar
  27. 27.
    Yukawa Y, Lenke LG, Tenhula J, Bridwell KH, Riew KD, Blanke K (2002) A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication. J Bone Joint Surg Am 84-A(11):1954–1959PubMedGoogle Scholar
  28. 28.
    Zanoli G, Stromqvist B, Jonsson B (2001) Visual analog scales for interpretation of back and leg pain intensity in patients operated for degenerative lumbar spine disorders. Spine 26(21):2375–2380PubMedCrossRefGoogle Scholar
  29. 29.
    Zeifang F, Abel R, Schiltenwolf M (2003) Possible conservative treatment methods for patients with spinal claudication. Orthopade 32(10):906–910PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Thomas Barz
    • 1
    • 2
  • Markus Melloh
    • 2
    • 3
    • 4
  • Lukas Staub
    • 3
    Email author
  • Christoph Roeder
    • 3
  • Jörn Lange
    • 1
  • Franz-Georg Smiszek
    • 1
  • Jean-Claude Theis
    • 4
  • Harry R. Merk
    • 1
  1. 1.Spine Center, Department of Orthopaedic SurgeryUniversity of GreifswaldGreifswaldGermany
  2. 2.Spine Unit, Department of Orthopaedic SurgeryAsklepios Klinikum UckermarkSchwedt/OderGermany
  3. 3.MEM Research Center for Orthopaedic Surgery, Institute for Evaluative Research in Orthopaedic SurgeryUniversity of BerneBerneSwitzerland
  4. 4.Department of Orthopaedic SurgeryDunedin Public Hospital, University of OtagoDunedinNew Zealand

Personalised recommendations