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Value of Additional Cervicothoracic Sagittal T2-weighted Images in Elderly Patients with Symptoms Suggestive of Lumbar Spinal Stenosis 2013

Category General Spine Sung Hee Park
Joon Woo Lee
Guen Young Lee
Heung Sik Kang
Purpose The purpose of this study was to analyze the incidence and predictive factors of tandem cervical spinal stenoses (CSS) in patients with lumbar spinal stenoses (LSS) based on MR Materials & Methods From January to May 2011, 140 consecutive patients (36 men, 94 women; mean age, 68.9 years; age range, 60–87 years) were included for the analysis. All patients were at least 60 years old, had undergone lumbar spine MR including additional cervicothoracic sagittal T2-weighted images (CT-sag-T2WI), and had clinically suspected LSS. MR images were interpreted in consensus by two spine radiologists focusing on the severity and presence of LSS and CSS, alignment disorder of the lumbar spine, and number of levels of LSS. A chi-square test was performed to determine the relation between the presence and severity of LSS and CSS. Univariate and multivariate analyses were performed to evaluate the risk factors for CSS considering possible risk factors such as age, sex, alignment disorder of the lumbar spine, number of levels of LSS, and severity of LSS. Results Of the 140 patients, 42 (30%) patients had TSS. CSS was more common among patients with LSS (42 of 61, 69%) than among patients without LSS (27 of 79, 34%) (p = .000). Grade 2 or 3 CSS was more commonly observed among patients with grade 2 or 3 LSS (15 of 53, 28%) than among patients with grade 0 or 1 LSS (8 of 87, 9%) (p = .003). The severity of LSS only showed a significant association with the severity of CSS after logistic regression analysis (p = .045). Conclusion Tandem CSS is common in LSS, and the severity of LSS is a risk factor of CSS. References 1. Teng P, Papatheodorou C. Combined cervical and lumbar spondylosis. Arch Neurol 1964;10:298–308. 2. Dagi TF, Tarkington MA, Leech JJ. Tandem lumbar and cervical spinal stenosis. Natural history, prognostic indices, and results after surgical decompression. J Neurosurg 1987;66:842–9. 3. LaBan MM, Green ML. Concurrent (tandem) cervical and lumbar spinal stenosis. A 10-yr review of 54 hospitalized patients. Am J Phys Med Rehabil 2004;83:187–90. 4. Epstein NE, Epstein JA, Carras R, et al. Coexisting cervical and lumbar spinal stenosis: diagnosis and management. Neurosurgery 1984;14:489–96. 5. Aydogan M, Ozturk C, Mirzanli C, et al. Treatment approach in tandem (concurrent) cervical and lumbar spinal stenosis. Acta Orthop Belg 2007;73:234–7. 6. Geun YL, Joon WL, Hee SC, et al. A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skeletal Radiol 2011 Feb 1. [Epub ahead of print]. 7. Hsieh CH, Huang TJ, Hsu RW. Tandem spinal stenosis: clinical diagnosis and surgical treatment. Changgeng Yi Xue Za Zhi 1998;21:429–35. 8. Naderi S, Mertol T. Simultaneous cervical and lumbar surgery for combined symptomatic cervical and lumbar spinal stenoses. J Spinal Disord Tech 2002;15:229–31. 9. Kikuike K, Miyamoto K, Hosoe H, et al. One-staged combined cervical and lumbar decompression for patients with tandem spinal stenosis on cervical and lumbar spine: analyses of clinical outcomes with minimum 3 years follow-up. J Spinal Disord Tech 200;22:593–601. 10. Eskander MS, Aubin ME, Drew JM, et al. Is there a difference between simultaneous or staged decompressions for combined cervical and lumbar stenosis? J Spinal Disord Tech 2010 Dec 8. [Epub ahead of print]. 11. Thomé C, Börm W, Meyer F. Degenerative lumbar spinal stenosis: current strategies in diagnosis and treatment. Dtsch Arztebl Int 2008;105:373–9. 12. Lee SH, Kim KT, Suk KS, et al. Asymptomatic cervical cord compression in lumbar spinal stenosis patients: a whole spine magnetic resonance imaging study. Spine (Phila Pa 1976) 2010;35:2057–63. 13. Lee MJ, Garcia R, Cassinelli EH, et al. Tandem stenosis: a cadaveric study in osseous morphology. Spine J 2008;8:1003–6. 14. Sirvanci M, Bhatia M, Ganiyusufoglu KA, et al. Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging. Eur Spine J 2008;17:679–85. 15. Muhle C, Metzner J, Weinert D, et al. Classification system based on kinematic MR imaging in cervical spondylitic myelopathy. AJNR Am J Neuroradiol 1998;19:1763–71.