Abstract
Purpose
Weight bearing does alter the dimension of lumbar spinal canal, but no study has analyzed its clinical correlation. This study aims to evaluate whether the changes in dural sac cross-sectional area (DSCA) and sagittal anteroposterior (AP) diameter on standing magnetic resonance imaging (MRI) correlate better with clinical symptoms of lumbar spinal stenosis.
Methods
Seventy consecutive patients with neurogenic claudication were prospectively recruited to undergo a 0.25-T MRI examination performed in supine and standing positions. Clinical symptoms including the walking distance, Visual Analogue Score of leg pain, Chinese Oswestry Disability Index, and short form-12 were assessed. DSCA and sagittal AP diameter at the most constricted spinal level on supine and standing positions were measured and correlated with each clinical symptom by Pearson correlation coefficients (r).
Results
DSCA and AP diameter on standing MRI and their % changes from supine to standing showed significant (r = 0.55, 0.53, −0.44, −0.43; p < 0.001) and better correlations than those on supine MRI (r = 0.39, 0.42; p < 0.001) with walking distance. Significant correlations were also found between dural sac calibers on standing MRI and leg pain scores (r = −0.20, r = −0.25; p < 0.05). Patients walking ≤500 m had a significantly smaller DSCA, narrower AP diameter and greater % change in dural sac calibers (p < 0.01) than those walking >500 m. A >30% reduction of DSCA and AP diameter was observed in patients with worse claudication distance (p < 0.05).
Conclusion
DSCA and sagittal AP diameter on standing MRI correlate significantly and better than findings on supine MRI with claudication symptoms. Standing MRI demonstrates dynamic changes of dural sac and provides an additional value to supine MRI in correlating clinical symptoms of lumbar spinal stenosis.
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Change history
03 August 2017
An erratum to this article has been published.
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Acknowledgements
The authors thank Professor De Feng Wang for calculation of dural sac cross-sectional area and radiographers of the Department of Imaging and Interventional Radiology at Prince of Wales Hospital for technical support.
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The original version of this article was revised.
An erratum to this article is available at https://doi.org/10.1007/s00586-017-5237-x.
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Lau, Y.Y.O., Lee, R.K.L., Griffith, J.F. et al. Changes in dural sac caliber with standing MRI improve correlation with symptoms of lumbar spinal stenosis. Eur Spine J 26, 2666–2675 (2017). https://doi.org/10.1007/s00586-017-5211-7
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DOI: https://doi.org/10.1007/s00586-017-5211-7