Anatomic radiological variations in developmental lumbar spinal stenosis: a prospective, control-matched comparative analysis

Abstract

Background context: Developmental lumbar spinal stenosis is a maldevelopment of the dorsal spinal elements involving short pedicles and a trefoil bony spinal canal that increases the likelihood of neural compression at an earlier age.

Purpose: To identify radiographically the anatomic variations caused by the maldevelopment of the infrequently characterized dorsal spinal elements.

Study design: A prospective, control-matched comparative analysis.

Methods: Magnetic resonance imaging (MRI) and anteroposterior (AP) plain radiographs of 66 patients (mean age, 40.7 years) selected and randomized prospectively and compared with images of 45, age- and gender-matched control subjects. Variables assessed included spinal canal cross-sectional area (CSA), thecal sac AP and transverse canal diameters (CSA), and interpedicular distance. All were expressed in ratios with vertebral body diameter (VBD), interlaminar angle, stenosis grade, and MRI evidence of disc degeneration.

Results: In the stenosis cohort, global pathology and multilevel involvement with L3, L4, and L5 segments were involved more commonly and severely. Severe stenosis, at L1, L2, and S1 occurs infrequently. Multivariate analysis demonstrated a statistically significant reduction in spinal canal CSA-to-vertebral body CSA ratio, AP spinal canal diameter-to-VBD ratio on axial and sagittal magnetic resonance images, and plain radiograph interpedicular distance-to-VBD ratio at all levels. Interlaminar angle and the transverse spinal canal diameter-to-VBD ratio were reduced significantly in the stenosed cohort at all levels, except L1. No statistically significant difference regarding the incidence of disc degeneration on MRI between the two cohorts, as well as thecal sac CSA-to-spinal canal CSA ratios across all levels were observed, except for L3 and S1 (p<.05).

Conclusions: Three spinal canal morphologies were identified: (1) "flattened" canal with predominantly reduced spinal canal AP diameter, (2) spinal canal with predominantly reduced interlaminar angle, and (3) global reduction of all canal parameters. Early age at presentation and subtle spondylosis, although typical, should not be considered the identifying, differentiating factors.

Keywords: Canal; Congenital; Developmental; Lumbar; MRI; Spine; Stenosis.