Skip to main content
Log in

A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

An Erratum to this article was published on 12 April 2011

Abstract

Objective

To introduce a new grading system of lumbar central canal stenosis, evaluate its reliabilities, and compare it to the cross-sectional area and anterior-posterior diameter of the dural sac.

Materials and methods

Lumbar central canal stenosis is defined as obliteration of the anterior CSF space in front of the cauda equina. Four musculoskeletal radiologists independently graded lumbar central canal stenosis by this new grading system based on separation degree of the cauda equina on T2-weighted axial images (grade 0 = no lumbar stenosis without obliteration of anterior CSF space; grade 1 = mild stenosis with separation of all cauda equina; grade 2 = moderate stenosis with some cauda equina aggregated; and grade 3 = severe stenosis with none of the cauda equina separated) in 81 patients to determine inter- and intra-reader reliability. One radiologist measured cross-sectional areas and anterior-posterior diameters and compared these to lumbar central canal stenosis grades.

Results

Inter-reader reliabilities were substantial to almost perfect (ICC reliability = 0.730–0.953). Intra-reader reliability was almost perfect (kappa value = 0.863–0.900). Cross-sectional areas and anterior-posterior diameters were different according to grades at all levels (p = 0.000–0.049), except between grades 2 and 3 of L2-3. At L5-S1, only anterior-posterior diameter was different between grades 0 and 1 (p = 0.005) and between grades 0 and 2 (p = 0.022).

Conclusions

This new grading system may be helpful to clinicians for simple and practical evaluation of lumbar central canal stenosis and for communicating with each other.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Taylor VM, Deyo RA, Cherkin DC, Kreuer W. Low back pain hospitalization: recent US trends and regional variation. Spine. 1994;19:1207–12.

    Article  PubMed  CAS  Google Scholar 

  2. Markman JD, Gaud KG. Lumbar spinal stenosis in older adults: current understanding and future directions. Clin Geriatr Med. 2008;24:369–88.

    Article  PubMed  Google Scholar 

  3. Ullrich CG, Binet EF, Sanechi MG, Kieffer SA. Quantitative assessment of the lumbar spinal canal by computed tomography. Radiology. 1980;134:137–43.

    PubMed  CAS  Google Scholar 

  4. Kornberg M, Rechtine GR. Quantitative assessment of the fifth lumbar spinal canal by computed tomography in symptomatic L4-L5 disc disease. Spine. 1985;10:328–30.

    Article  PubMed  CAS  Google Scholar 

  5. Bolender MF, Schonstrom NS, Spengler DM. Role of computed tomography and myelography in the diagnosis of central spinal stenosis. J Bone Joint Surg Am. 1985;67:240–6.

    PubMed  CAS  Google Scholar 

  6. Karantanas AH, Zibis AH, Papaliaga M, Georgiou E, Rousogiannis S. Dimensions of the lumbar spinal canal: variations and correlations with somatometric parameters using CT. Eur Radiol. 1998;8:1581–5.

    Article  PubMed  CAS  Google Scholar 

  7. Lohman CM, Tallroth K, Kettunen JA, Lindgren KA. Comparison of radiologic signs and clinical symptoms of spinal stenosis. Spine. 2006;31:1834–40.

    Article  PubMed  Google Scholar 

  8. Zheng F, Farmer JC, Sandhu HS, O’Leary PF. A novel method for the quantitative evaluation of lumbar spinal stenosis. HSS J. 2006;2:136–40.

    Article  PubMed  Google Scholar 

  9. Athiviraham A, Yen D, Scott C, Soboleski D. Clinical correlation of radiologic spinal stenosis after standardization for vertebral body size. Clin Radiol. 2007;62:776–80.

    Article  PubMed  CAS  Google Scholar 

  10. Rapala K, Chaberek S, Truszczynska A, Lukawski S, Walczak P. Digital computed tomography affords new measurement possibilities in lumbar stenosis. Ortop Traumatol Rehabil. 2009;11:13–26.

    PubMed  Google Scholar 

  11. Modic MT, Masaryk T, Boumphrey F, Goormastic M, Bell G. Lumbar herniated disc disease and canal stenosis: prospective evaluation by surface coil MR, CT and myelography. AJR. 1986;147:757–65.

    PubMed  CAS  Google Scholar 

  12. Hamanish C, Matukura N, Fukita M, Tomihara M, Tanaka S. Cross-sectional area of the stenotic lumbar dural tube measured from the transverse views of magnetic resonance imaging. J Spinal Disord. 1994;7:388–93.

    Google Scholar 

  13. Laurencin CT, Lipson SJ, Senatus P, et al. The stenosis ratio: a new tool for the diagnosis of degenerative spinal stenosis. Int J Surg Investig. 1999;1:127–31.

    PubMed  CAS  Google Scholar 

  14. Ogikubo O, Forsberg L, Hansson T. The relationship between the cross-sectional area of the cauda equina and the preoperative symptoms in central lumbar spinal stenosis. Spine. 2007;32:1423–8.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Speciale AC, Pietrobone R, Urban CW, et al. Observer variability in assessing lumbar spinal stenosis severity on magnetic resonance imaging and its relation to cross-sectional spinal canal area. Spine. 2002;27:1082–6.

    Article  PubMed  Google Scholar 

  17. Amundsen T, Weber H, Nordal LF, HJ AM, Magnaes B. Lumbar spinal stenosis: Clinical and radiologic features. Spine. 1995;20:1178–86.

    Article  PubMed  CAS  Google Scholar 

  18. Boden SD, McCown PR, Davis DO, Dina TS, Mark AS, Wiesel S. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990;72:1178–84.

    PubMed  CAS  Google Scholar 

  19. Deyo RA, Ciol MA, Cherkin DC, Loeser JD, Bigos SJ. Lumbar spinal fusion: A cohort study of complications, reoperations, and resource use in the Medicare population. Spine. 1993;18:1463–70.

    PubMed  CAS  Google Scholar 

  20. Herron LD, Manglesdorf C. Lumbar spinal stenosis: Results of surgical treatment. J Spinal Disord. 1991;4:26–33.

    CAS  Google Scholar 

  21. Uden A, Johnsson KE, Jonsson K, Pettersson H. Myelography in the elderly and the diagnosis of spinal stenosis. Spine. 1985;10:171–4.

    Article  PubMed  CAS  Google Scholar 

  22. Weir B, DeLeo R. Lumbar stenosis. Analysis of factors affecting outcome in 81 surgical cases. Can J Neurol Sci. 1981;8:295–8.

    PubMed  CAS  Google Scholar 

  23. Verbiest H. Results of surgical treatment of idiopathic developmental stenosis of the lumbar vertebral canal: A review of twenty-seven years' experience. J Bone Joint Surg Br. 1977;59:181–8.

    PubMed  CAS  Google Scholar 

  24. Jonsson B, Annertz M, Sjoberg C, Stromqvist B. A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part I: clinical features related to radiographic findings. Spine. 1997;22:2932–7.

    Article  PubMed  CAS  Google Scholar 

  25. Chiodo A, Haig AJ, Yamakawa KS, Quint D, Tong H, Choksi VR. Magnetic resonance imaging vs. electrodiagnostic root compromise in lumbar spinal stenosis: a masked controlled study. Am J Phys Med Rehabil. 2008;87:789–97.

    Article  PubMed  Google Scholar 

  26. Chiodo A, Haig AJ, Yamakawa KS, Quint D, Tong H, Choksi VR. Magnetic resonance imaging vs. electrodiagnostic root compromise in lumbar spinal stenosis: a masked controlled study. Am J Phys Med Rehabil 2008; 87:789–79726.

    Google Scholar 

  27. Song KS, Jang EC, Jung HJ, Kim KW, Yu H. Observer variability in the evaluation of multiple lumbar stenosis by routine MR-myelography and MRI. J Spinal Disord Tech 2008;21569–574.

  28. Schizas C, Theumann N, Burn A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine. 2010;35:1919–24.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors declare that there is no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Woo Lee Joon.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00256-011-1153-z

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guen, Y.L., Joon, W.L., Hee, S.C. et al. A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skeletal Radiol 40, 1033–1039 (2011). https://doi.org/10.1007/s00256-011-1102-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-011-1102-x

Keywords

Navigation