1
|
Hashimoto K, Tanaka Y, Tsubakino T, Hoshikawa T, Kawahara C, Nakagawa T, Tateda S, Takahashi K, Suzuki M, Onoki T, Kanno H, Morozumi N, Koizumi Y, Honda M, Kusakabe T, Suda M, Kokubun S, Aizawa T. Are T1-Weighted Three-Dimensional Magnetic Resonance Images Inferior to T2-Weighted Images for Diagnosing Lumbar Foraminal Stenosis in the Fifth Lumbar Nerve Root? A Prospective, Comparative Study in Identical Patients. Spine Surg Relat Res 2023; 7:436-442. [PMID: 37841035 PMCID: PMC10569809 DOI: 10.22603/ssrr.2023-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/16/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Imaging analysis of foraminal stenosis in the fifth lumbar (L5) nerve root remains to be a challenge because of the anatomical complexity of the lumbosacral transition. T2-weighted three-dimensional (3D) magnetic resonance images (MRI) have been dominantly used for diagnosis of lumbar foraminal stenosis, while the reliability of T1-weighted images (WI) has also been proven. In this study, we aim to compare the reliability and reproducibility of T1- and T2-weighted 3D MRI in diagnosing lumbar foraminal stenosis (LFS) of the L5 nerve root. Methods In this study, 39 patients with unilateral L5 radiculopathy (20 had L4-L5 intracanal stenosis; 19 had L5-S foraminal stenosis) were enrolled, prospectively. T1- and T2-weighted 3D lumbar MRI were obtained from each patient. T1WI and T2WI were blinded and then separately reviewed twice by four examiners randomly. The examiners were instructed to answer the side of LFS or absence of LFS. The correct answer rate, sensitivity, specificity, and area under the curve were analyzed and compared between T1WI and T2WI. Also, intra- and interobserver agreements were calculated using kappa (κ)-statistics and compared in the same manner. Results The average correct answer rate, sensitivity, specificity, and area under the curve of the T1WI/T2WI were 84.6%/80.1%, 82.9%/80.3%, 86.3%/81.3%, and 0.846/0.801, respectively. The intraobserver κ-values of the four examiners ranged from 0.692 to 0.916 (average: 0.762) and from 0.669 to 0.801 (average: 0.720) for T1WI and T2WI, respectively. The interobserver κ-values calculated in a round-robin manner (24 combinations in total) ranged from 0.544 to 0.790 (average: 0.657) and from 0.524 to 0.828 (average: 0.652), respectively. Conclusions As per our findings, T1- and T2-weighted 3D MRI were determined to have nearly equivalent reliability and reproducibility in terms of diagnosing LFS of the L5 nerve root.
Collapse
Affiliation(s)
- Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Orthopaedic Surgery, Tohoku Central Hospital, Yamagata, Japan
| | - Yasuhisa Tanaka
- Department of Orthopaedic Surgery, Tohoku Central Hospital, Yamagata, Japan
| | - Takumi Tsubakino
- Department of Orthopaedic Surgery, Tohoku Central Hospital, Yamagata, Japan
| | | | - Chikashi Kawahara
- Department of Orthopaedic Surgery, Sendai Nishitaga Hospital, Sendai, Japan
| | | | - Satoshi Tateda
- Department of Orthopaedic Surgery, Ishinomaki Red Cross Hospital, Ishinomaki, Japan
| | - Kohei Takahashi
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Orthopaedic Surgery, Tohoku Central Hospital, Yamagata, Japan
| | - Manabu Suzuki
- Department of Orthopaedic Surgery, Tohoku Central Hospital, Yamagata, Japan
- Department of Orthopaedic Surgery, Sendai Nishitaga Hospital, Sendai, Japan
| | - Takahiro Onoki
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Orthopaedic Surgery, Takeda General Hospital, Aizu-wakamatsu, Japan
| | - Haruo Kanno
- Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Naoki Morozumi
- Department of Orthopaedic Surgery, Sendai Nishitaga Hospital, Sendai, Japan
| | - Yutaka Koizumi
- Department of Orthopaedic Surgery, Sendai Nishitaga Hospital, Sendai, Japan
| | - Masahito Honda
- Department of Orthopaedic Surgery, Takeda General Hospital, Aizu-wakamatsu, Japan
| | - Takashi Kusakabe
- Department of Orthopaedic Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | - Masaru Suda
- Department of Radiology, Tohoku Central Hospital, Yamagata, Japan
| | - Shoichi Kokubun
- Department of Orthopaedic Surgery, Sendai Nishitaga Hospital, Sendai, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
2
|
Lin YT, Wang JS, Hsu WE, Lin YH, Wu YC, Chen KH, Pan CC, Lee CH. Correlation of Foraminal Parameters with Patient-Reported Outcomes in Patient with Degenerative Lumbar Foraminal Stenosis. J Clin Med 2023; 12:jcm12020479. [PMID: 36675407 PMCID: PMC9861602 DOI: 10.3390/jcm12020479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
The relationship between quantitative anatomic parameters in MRI and patient-reported outcomes (PROs) before and after surgery in degenerative lumbar foraminal stenosis remains unknown. We included 58 patients who underwent transforaminal lumbar interbody fusion (TLIF) for single-level degenerative disc disease with foraminal stenosis between February 2013 and June 2020. PROs were evaluated using the visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D). The foraminal parameters assessed using preoperative MRI included foraminal height, posterior intervertebral disc height, superior and inferior foraminal width, and foraminal area. The correlation between foraminal parameters and PROs before operation, at 1 year follow-up, and change from baseline were assessed. The associations between the aforementioned parameters were examined using linear regression analysis. The analysis revealed that among these parameters, superior foraminal width was found to be significantly correlated with ODI and EQ-5D at the 1 year follow-up and with change in ODI and EQ-5D from baseline. The associations remained significant after adjustment for confounding factors including age, sex, body mass index, and duration of hospital stay. The results indicated that in degenerative lumbar foraminal stenosis, decreased superior foraminal width was associated with better improvement in disability and quality of life after TLIF.
Collapse
Affiliation(s)
- Yu-Tsung Lin
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Jun-Sing Wang
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Wei-En Hsu
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yu-Hsien Lin
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yun-Che Wu
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Computer Science and Information Engineering, Providence University, Taichung 43301, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing, and Management, Miaoli 35664, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Food Science and Technology, Hung Kuang University, Taichung 43304, Taiwan
- Correspondence: ; Tel.: +886-4-23592525 (ext. 5101)
| |
Collapse
|
3
|
Is the Severity of Cervical Foraminal Stenosis Related to the Severity and Sidedness of Symptoms? Healthcare (Basel) 2021; 9:healthcare9121743. [PMID: 34946469 PMCID: PMC8701450 DOI: 10.3390/healthcare9121743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Cervical foraminal stenosis (CFS) is a common cause of axial neck and arm pain. The aim of this study was to determine the relationship between the severity of CFS and clinical symptoms in terms of severity and sidedness. (2) Methods: We retrospectively reviewed 75 consecutive patients with degenerative CFS. We graded 900 foramina from C3–4 to T1–2 using Park’s grading system. We collected visual analogue scale (VAS) and neck disability index (NDI) values from the neck and both arms. We analyzed the relationships with CFS grades and total number. We defined four types of left/right dominance of CFS (none, left-dominant, right-dominant, and both) by comparing left and right sides using total counts and maximal grade of CFS, respectively. We compared arm pain sidedness (no arm pain, left-only, right only, and bilateral) among different left and right CFS dominance types. (3) Results: Mean neck and left and right arm VAS scores were 4.4 ± 2.5, 4.9 ± 1.6, and 4.6 ± 2.0, respectively. The mean total NDI was 16.0 ± 8.0. The CFS grade at C3–4 and total count were correlated with neck VAS. Arm VAS was also correlated with CFS grade and total counts. Total NDI score was not correlated with radiological parameters. The presence and sidedness of arm pain were significantly different between left and right CFS dominance groups divided by total count of grade 2 and 3 CFS. (4) Conclusions: The CFS grade and total count were correlated with neck and arm VAS. Arm pain occurred more frequently on the side with more grade 2 and 3 CFS.
Collapse
|
4
|
Hasib MM, Yamada K, Hoshino M, Yamada E, Tamai K, Takahashi S, Suzuki A, Toyoda H, Terai H, Nakamura H. Can Conventional Magnetic Resonance Imaging Substitute Three-Dimensional Magnetic Resonance Imaging in the Diagnosis of Lumbar Foraminal Stenosis? Asian Spine J 2020; 15:472-480. [PMID: 33059434 PMCID: PMC8377208 DOI: 10.31616/asj.2020.0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/12/2020] [Indexed: 12/02/2022] Open
Abstract
Study Design Retrospective radiological comparative design. Purpose To investigate whether conventional magnetic resonance imaging (MRI) could substitute three-dimensional (3D)-MRI for the calculation of the foraminal stenotic ratio (FSR) and clarification of which patients can be assessed more accurately using 3D-MRI. Overview of Literature Previous studies have indicated that 3D-MRI is useful for diagnosing lumbar foraminal stenosis. The FSR obtained using 3D-MRI, described as the ratio of stenosis length, characterized by perineural fat obliteration, to the length of the entire foramen, could indicate the stenosis severity; however, this method is time-consuming and expensive. The FSR also can be calculated using conventional MRI. Methods We investigated 154 foramina at L5–S1 in 77 patients. All the patients had degenerative lumbar disorders and had undergone both conventional MRI and 3D-MRI during the same visit. Differences between the FSRs calculated from conventional and 3D-MRI reconstructions and any correlations with the plain radiography findings were assessed. Results In foramina that had a FSR of <50% on conventional MRI, the difference between the FSR obtained using conventional MRI and 3D-MRI was 5.1%, with a correlation coefficient of 0.777. For foramina with a FSR ≥50% on conventional MRI, the difference was 20.2%, with a correlation coefficient of 0.54. FSR obtained using 3D-MRI was significantly greater in patients who required surgery than in those who were successfully treated with conservative methods (88% and 42%, respectively). Segments with spondylolisthesis or lateral wedging showed higher FSRs than those without these conditions on both types of MRI. Conclusions FSRs <50% obtained using conventional MRI were sufficiently reliable; however, the results were inaccurate for FSRs ≥50%. Patients with high FSRs on 3D-MRI were more likely to require surgical treatment. Therefore, 3D-MRI is recommended in patients with suspected stenosis detected using conventional MRI or plain radiographs.
Collapse
Affiliation(s)
| | - Kentaro Yamada
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan.,Department of Orthopaedic Surgery, Fuchu Hospital, Osaka, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Eiji Yamada
- Division of Central Radiology, Osaka City University, Osaka, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| |
Collapse
|