The weight of MRI parameters in responsible segment determination of multi-segmental lumbar spinal stenosis
ZHANG Zhenhua1, JI Xiang1, DU Mingkui1,2, JIN Kaifeng1, CHEN Xuanyu1, ZHONG Weitao1, ZHAO Hui1, ZHANG Liming1
1. Department of Orthopedics, Electric Power Teaching Hospital of Capital Medical University, Beijing 100073, China; 2. Department of Orthopedics, the Third Medical Center of Chinese PLA General Hospital,Beijing 100039, China
Abstract：Objective To analyze the weight of MRI parameters in the determination of segments responsible for multisegmental lumbar spinal stenosis, and to establish a related score scale.Methods The clinical data on patients with multilevel lumbar spinal stenosis treated in the Second Department of Orthopaedics of Beijing Electric Power Hospital and in the Third Medical Center of the PLA General Hospital between December 2015 and May 2019 was retrospectively analyzed. A total of 86 patients were enrolled according to the admission criteria.One year after surgery, the lumbar functional recovery was evaluated according to the modified Macnab score. Patients with excellent and good results of evaluation were classified as the group of correct assessment of responsible segments, while those with fair and poor results were assigned to the group of incorrect assessment. The clinical and imaging data was compared between the two groups to obtain the risk factors for segments of responsibility. The OR value was used as the standard, and each risk factor was scored according to the degree of correlation. The judgment table of segments of responsibility was established, and the optimal cutoff point of the rating table was determined by using the ROC curve.Results The patients in our research included 51 males and 35 females. Multivariate logistic regression analysis showed that risk factors that could predict responsible segments included cauda equina syndrome, L4-5 dural sac cross-sectional areas of less than 100 mm2, L5-S1 dural sac cross-sectional areas of less than 100 mm2 , a less-than-3mm sagittal diameter of the crypt on the L4-5 side is, which were given 4,4,4 and 4 points respectively based on their OR value(18.79, 11.82, 13.80, 16.72).The total score was 16 points. The AUC area of the scoring table was 0.903, and the sensitivity and specificity for judgment of responsible segments were 83.9% and 83.3% respectively when the cutoff point was 6 points.Conclusions The judgment table for responsible segments established based on the results of nuclear magnetic measurement is effective in determining the segment responsible for multi-segment lumbar spinal stenosis. The segment with a total score of 6 points or above is likely to be the responsible segment.
Stalcup S T, Crall T S, Gilula L, et al. Influence of needle-tip position on the incidence of immediate complications in 2,217 selective lumbar nerve root blocks [J]. Spine J, 2006,6(2):170-176.
[10]
Aprill C N, Melfi R S. Paraplegia after lumbosacral nerve root block: report of three cases [J].Spine J,2004,4(3):368-369.
Splettstosser A, Khan M F, Zimmermann B, et al. Correlation of lumbar lateral recess stenosis in magnetic resonance imaging and clinical symptoms [J].World J Radiol,2017,9(5):223-229.
[15]
Li X, Bai X, Wu Y, et al. A valid model for predicting responsible nerve roots in lumbar degenerative disease with diagnostic doubt[J]. BMC Musculoskelet Disord,2016,17(7):128.
2022, Vol. 33 
