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Imaging maintains key role in evaluating spondylolisthesis
Study finds that location of stenosis is associated with symptom pattern and severity.
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Magnetic resonance imaging findings on the severity of spinal stenosis and the number of levels affected do not necessarily relate to clinical symptoms or disability at baseline, according to a recent study. However, investigators found that the anatomical location of stenosis is associated with both the pattern and severity of symptoms.
Heike Braeutigam, MD, of Dartmouth Medical School in Hanover, N.H., presented the study’s findings at the International Society for the Study of the Lumbar Spine 32nd Annual Meeting. Researchers from Dartmouth and the Hospital for Joint Diseases in New York enrolled 303 patients with degenerative spondylolisthesis (DS) in an observational cohort of SPORT (Spine Patient Outcomes Research Trial).
“Imaging, in particular magnetic resonance imaging, plays a key role in the evaluation of spondylolisthesis with or without degenerative spondylolisthesis,” Braeutigam said. “However, the relationship between MRI abnormalities and clinical presentation of spondylolisthesis is still discussed controversially.”
The impact of imaging
During the study, an enrolling physician recorded imaging rates, noting the stenosis severity (mild, moderate or severe) and the affected areas, including central canal, lateral recess and/or neuroforamina. These rates were compared to clinical baseline features, including demographics, self-recorded health statements and exam findings.
The study found that 188 patients had their worst stenosis level rated as severe, 99 patients had their worst level rated as moderate, and 16 were rated as mild. Ninety-three patients had two or more moderate/severe stenotic levels.
Regarding affected areas, 275 patients (91%) had central canal stenosis, 264 (87%) demonstrated lateral recess stenosis and 124 (41%) had some neuroforaminal stenosis.
Comparison of the imaging rates with the baseline features showed that the stenosis severity and number of levels affected were not associated with the degree of back pain, leg pain or disability. However, researchers found that those patients with severe stenosis were more likely to encounter bilateral claudication symptoms than those with moderate stenosis.
MRI vs. baseline features
With a mean age of 66.3 years, the cohort consisted of 71% females. Of these patients, 83% were white and 10% were black. Further demographic evaluation showed that 20% of patients were full-time workers, 25% were retired, 11% were homemakers, 20% were disabled and 7% received workers’ compensation.
Researchers found that symptoms lasted less than six months for 41% of patients, six months to two years for 43% of patients and more than two years for 16% of patients. Of the 303 patients, 83% suffered from claudication (27% on one side and 56% on both sides), while 77% of patients showed a radicular pain pattern (35% on one level and 42% on more than one level).
Patients with stenosis of the lateral recesses and neuroforamina experienced symptoms for less time than those with central stenosis, according to the presentation abstract. These patients were also less likely to display claudication symptoms.
“The mean frequency and ‘bothersomeness’ of leg pain on a scale from 0 to 6 was 4.4, and the mean frequency and ‘bothersomeness’ of back pain was a mean of 4.2,” Braeutigam said. The mean for the Oswestry Disability Index (ODI) — AAOS/MODEMS version — was 41.4; the mean for the SF-36 bodily pain score was 33.8; and the mean for the SF-36 physical functioning (PF) score was 34.3.
Comparison results demonstrated that neuroforaminal stenosis was associated with worse pain on the SF-36 scale, lower physical function on the SF-36 PF scale and greater disability on the ODI. Patients with asymmetric involvement of a lateral recess or neuroforamen were found more likely to display pain in a single dermatome.
For more information:
- Braeutigam H, Lurie JD, Hanscom B, et al. Relationship between clinical symptoms and MRI findings in patients with degenerative spondylolisthesis in SPORT. #56. Presented at the International Society for the Study of the Lumbar Spine 32nd Annual Meeting. May 10-14, 2005. New York.