Title

Redefining lumbar spinal stenosis as a developmental syndrome: An MRI-based multivariate analysis of findings in 709 patients throughout the 16- to 82-year age spectrum

Document Type

Article

Abstract

© 2018 AANS. Objective: Using an imaging-based prospective comparative study of 709 eligible patients that was designed to assess lumbar spinal stenosis (LSS) in the ages between 16 and 82 years, the authors aimed to determine whether they could formulate radiological structural differences between the developmental and degenerative types of LSS. Methods: MRI structural changes were prospectively reviewed from 2 age cohorts of patients: those who presented clinically before the age of 60 years and those who presented at 60 years or older. Categorical degeneration variables at L1-S1 segments were compared. A multivariate comparative analysis of global radiographic degenerative variables and spinal dimensions was conducted in both cohorts. The age at presentation was correlated as a covariable. Results: A multivariate analysis demonstrated no significant between-groups differences in spinal canal dimensions and stenosis grades in any segments after age was adjusted for. There were no significant variances between the 2 cohorts in global degenerative variables, except at the L4-5 and L5-S1 segments, but with only small effect sizes. Agerelated degeneration was found in the upper lumbar segments (L1-4) more than the lower lumbar segments (L4-S1). These findings challenge the notion that stenosis at L4-5 and L5-S1 is mainly associated with degenerative LSS. Conclusions: Integration of all the morphometric and qualitative characteristics of the 2 LSS cohorts provides evidence for a developmental background for LSS. Based on these findings the authors propose the concept of LSS as a developmental syndrome with superimposed degenerative changes. Further studies can be conducted to clarify the clinical definition of LSS and appropriate management approaches.

Publication Date

12-1-2018

Publication Title

Journal of Neurosurgery: Spine

ISSN

15475654

E-ISSN

15475646

Volume

29

Issue

6

First Page

654

Last Page

660

PubMed ID

30215592

Digital Object Identifier (DOI)

10.3171/2018.5.SPINE18100

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