Article

MRI is the modality of choice when diagnosing spinal
stenosis but it also shows that stenosis is prevalent in asymptomatic subjects
over 60. The relationship between preoperative health-related quality of life,
functional status, leg and back pain, and the objectively measured dural sac area
in single and multilevel stenosis is unknown. We assessed this relationship in a
prospective study. METHODS: The cohort included 109 consecutive
patients with central spinal stenosis operated on with decompressive laminectomy
or laminotomy. Preoperatively, all patients completed the questionnaires for
EQ-5D, SF-36, Oswestry disability index (ODI), estimated walking distance and leg
and back pain (VAS). The cross-sectional area of the dural sac was measured at
relevant disc levels in mm(2), and spondylolisthesis was measured in mm. For
comparison, the area of the most narrow level, the number of levels with dural
sac area < 70 mm(2), and spondylolisthesis were studied. RESULTS: Before surgery,
patients with central spinal stenosis had low HRLQoL and functional status, and
high pain levels. Patients with multilevel stenosis had better general health (p
= 0.04) and less leg and back pain despite having smaller dural sac area than
patients with single-level stenosis. There was a poor correlation between walking
distance, ODI, the SF-36, EQ-5D, and leg and back pain levels on the one hand and
dural sac area on the other. Women more often had multilevel spinal stenosis (p =
0.05) and spondylolisthesis (p < 0.001). Spondylolisthetic patients more often
had small dural sac area (p = 0.04) and multilevel stenosis
(p = 0.06).
INTERPRETATION: Our findings indicate that HRQoL, function, and pain measured
preoperatively correlate with morphological changes on MRI to a limited extent.

Langue : ANGLAIS