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. 2011 Jul 28:12:175.
doi: 10.1186/1471-2474-12-175.

Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review

Johann Steurer  1 , Simon Roner, Ralph Gnannt, Juerg Hodler; LumbSten Research Collaboration
Affiliations

Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review

Johann Steurer et al. BMC Musculoskelet Disord. .

Abstract

Background: Beside symptoms and clinical signs radiological findings are crucial in the diagnosis of lumbar spinal stenosis (LSS). We investigate which quantitative radiological signs are described in the literature and which radiological criteria are used to establish inclusion criteria in clinical studies evaluating different treatments in patients with lumbar spinal stenosis.

Methods: A literature search was performed in Medline, Embase and the Cochrane library to identify papers reporting on radiological criteria to describe LSS and systematic reviews investigating the effects of different treatment modalities.

Results: 25 studies reporting on radiological signs of LSS and four systematic reviews related to the evaluation of different treatments were found. Ten different parameters were identified to quantify lumbar spinal stenosis. Most often reported measures for central stenosis were antero-posterior diameter (< 10 mm) and cross-sectional area (< 70 mm(2)) of spinal canal. For lateral stenosis height and depth of the lateral recess, and for foraminal stenosis the foraminal diameter were typically used. Only four of 63 primary studies included in the systematic reviews reported on quantitative measures for defining inclusion criteria of patients in prognostic studies.

Conclusions: There is a need for consensus on well-defined, unambiguous radiological criteria to define lumbar spinal stenosis in order to improve diagnostic accuracy and to formulate reliable inclusion criteria for clinical studies.

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Figures

Figure 1
Figure 1
Flowchart of search results in Medline, Embase and bibliographies.
Figure 2
Figure 2
Transaxial computed tomography image of the lumbar spine at the level of L4. The white arrow indicates the transverse diameter of the osseous spinal canal.
Figure 3
Figure 3
T2 weighted sagittal fast spin echo MR image of the middle lumbar spine. The black arrow indicates the antero-posterior diameter of the osseous spinal canal.
Figure 4
Figure 4
T2 weighted transaxial fast spin echo MR image of the lumbar spine at the level of L3. The white arrow indicates the ligamentous interfacet distance measured between the inner surfaces of flaval ligaments on a line connecting the joint space of facet joints.
Figure 5
Figure 5
T2 weighted transaxial fast spin echo MR image of the lumbar spine at the level of L1. Cross sectional area of the spinal canal is indicated by the white hatched area.
Figure 6
Figure 6
T2 weighted transaxial fast spin echo MR image of the lumbar spine at the level of L5. The depth of the lateral recess is measured between the superior articular facet and the top part of the pedicle marked with the black arrow.
Figure 7
Figure 7
Transaxial computed tomography image of the lumbar spine at the level of L3. Left side: The lateral recess angle is defined as the angle between the lines parallel to the floor and the roof of the lateral recess. Right side: The height of the lateral recess is defined as the shortest distance from the most anterior point of the superior articular process to the posterior border of the vertebral body.
See this image and copyright information in PMC

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