Clinical Study on Lumbar Stenosis Using Computed Tomography.
- Author:
Yong Eun CHO
1
;
Young Soo KIM
Author Information
1. Department of Neurosurgery, Yonsei University, College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Lumbar spinal stenosis;
Spinal CT measurement;
Spinal canal size;
Yellow ligament angle
- MeSH:
Ankle;
Back Pain;
Cauda Equina;
Constriction, Pathologic*;
Contrast Media;
Diagnosis;
Female;
Foraminotomy;
Humans;
Hypertrophy;
Incidence;
Laminectomy;
Leg;
Ligaments;
Male;
Neurosurgery;
Osteophyte;
Spinal Canal;
Spine;
Spondylolisthesis;
Tomography, X-Ray Computed
- From:Journal of Korean Neurosurgical Society
1988;17(5):1013-1028
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Since developmental lumber atenosis was described by Verbiest in 1954, there have been many reports on lumbar stenosis. But there have been many limitations in diagnosis and treatment of lumbar stenosis. Recently, the development of water-soluble contrast media and high resolution spine CT scan have not only brought about significant progress in diagnosis of the etiology and levels of lumbar stenosis, but also better surgical therapetic results could be expected. The author has reviewed 433 patients with lumber stenosis operated at the department of Neurosurgery YUMC Yongdong Severance hospital from March 1983 to September 1987 and analyzed the measurements of various parts of the spinal canal by high resolution spine CT scan, and evaluated the clinical courses and their surgical outcomes. The results were summarized as following: 1) Male to female ratio was 1:1.3. The peak age incidence were 40's in male and 50's in female. 2) By the causes of lumbar stenosis, degenerative stenosis was most common as 78%, and followed by degenerative spondylolisthesis 7.2%, spondylolytic spondylolisthesis(1.6%), iatrogenic stenosis(1.6%), developmental stenosis(0.7%) and posttraumatic stenosis(0.7%). 3) Single level stenosis was most common(47.1%), two levels 32.8% and three levels or more 20.1%. In the single level stenosis L4/5 was most common as 85.8% and L5/S1 10.3%. In the two levels stenosis, L4/5 and L4/S1 were most common at 72.5% and L3/4 and L4/5 26.1%. 4) The characteristic clinical symptoms were chronic back pain and neurogenic intermittent claudication(65.6%). Few patient showed abnormal neurological findings. Common abnormal sign was loss or decrease of ankle jerk(73%). The straight leg raising test was not significant, and it was positive only in 10.3%. 5) In diagnosis of lumbar stenosis, it was most important to identify the causes of lumbar stenosis and degree of compression on cauda equina, or lateral recess stenosis by the spine CT or spine CT myelograms. 6) On myelogram, the findings of complete or incomplete block were present in 44.1%, and indentations of contrast dye column at the levels of stenosis was noted in 55.9%. 7) The common findings on spine CT scan were hypertrophy of posterior articular facet joints(65.8%), osteophyte formation(37.1%), thicking of yellow ligament(21.7%), ossification of posterior longitudinal ligament(23.8%), ossification of yellow ligament(4.9%). 8) In the diagnosis of degenerative lumbar stenosis with high resolution of spine CT scan, anteroposterior diameter of spinal canal was not so significant, but the cross sectional areas of dural sac and spinal canal were most sensitive indexes. The anteroposterior diameter of dural sac and interfacetal distance provided th e clue of lumbar stenosis. If the anteroposterior diameter of the lateral recess was less than 3mm it could be diagnosed as the lateral recess stenosis. And if the angle between both yellow ligaments(yellow ligament angle, Y-angle) was less than 60( it must be suspected as the central stenosis. 9) In the examination of degenerative spondylolisthesis with spinal CT scan, anterior-posterior diameter and cross sectional area of spinal canal and dural sac at the disc level were smaller than those of upper and lower vertebral levels. The angle of yellow ligament was almost normal. 10) For the definite treatment wide decompressive laminectomy, medial facetectomy and foraminotomy should be carried out. 11) Our results of surgery were good to excellent in 90.3% and fair to poor 9.7%.
