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Computed Tomography Findings 4 Years After Surgical Management of Lumbar Spinal Stenosis: No Correlation With Clinical Outcome

Herno, Arto, MD, PhD*; Airaksinen, Olavi, MD, PhD*; Saari, Tapani, MD; Pitkänen, Marja, MD; Manninen, Hannu, MD, PhD; Suomalainen, Olavi, MD, PhD

Clinical Case Study
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Study Design. A prospective, cross-sectional study of the correlation between postoperative computed tomography findings and patients’ clinical outcomes approximately 4 years after laminectomy for lumbar spinal stenosis.

Objectives. To evaluate clinical and radiologic characteristics and their relation to each other.

Summary of Background Data. The goal of surgical management for lumbar spinal stenosis is to decompress the stenotic area determined in radiologic examinations to relieve pressure on the neurovascular structures. However, the success of this decompression very rarely has been confirmed by postoperative radiologic imaging or compared with clinical outcome.

Methods. Postoperative computed tomography was performed on 191 patients. The findings were classified as “no stenosis,” “central stenosis,” “lateral stenosis,” or “central-lateral stenosis.” Postoperative instability of the lumbar spine was investigated by functional radiography. Clinical status was assessed by clinical examination. Subjective disability was assessing using the Oswestry questionnaire, and severity of pain using the visual analog scale. Walking capacity was evaluated by the treadmill test.

Results. Radiologic studies revealed postoperative stenosis in 123 patients (64%). Small differences between the computed tomography groups were shown for the Oswestry score, but not for walking distance. Clinical signs, severity of pain, and radiologic instability were very similar for all computed tomography groups.

Conclusions. Postoperative radiologic stenosis was very common in patients operated on for lumbar spinal stenosis, but this did not correlate with clinical outcome. The clinician must be cautious when reconciling clinical symptoms and signs with postoperative computed tomography findings in patients operated on for lumbar spinal stenosis.

From the Departments of *Physical and Rehabilitation Medicine, †Clinical Radiology, and ‡Surgery, Kuopio University Hospital, Kuopio, Finland.

Acknowledgment date: January 21, 1998.

First revision date: April 21, 1998.

Acceptance date: August 24, 1998.

Address reprint requests to

Arto Herno, MD, PhD

Department of Physical and Rehabilitation Medicine

Kuopio University Hospital, SF-70210 Kuopio

Finland

E-mail:arto.herno@kuh.fi

Device status category: 1.

© 1999 Lippincott Williams & Wilkins, Inc.