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Preoperative MRI in Patients With Intermittent Neurogenic Claudication: Relevance for Diagnosis and Prognosis

Moojen, Wouter A., MSc, MD, PhD∗,†; Schenck, Catharina D., MD; Lycklama à Nijeholt, Geert J., MD, PhD; Jacobs, Wilco C.H., MSc, PhD; Van der Kallen, Bas F., MD; Arts, Mark P., MD, PhD; Peul, Wilco C., MD, MBA, PhD∗,†; Vleggeert-Lankamp, Carmen L.A.M., MD, PhD; for the Leiden-The Hague Spine Intervention Prognostic Study Group (SIPS)

doi: 10.1097/BRS.0000000000001301

Study Design. We studied baseline magnetic resonance images of 155 patients with intermittent neurogenic claudication and lumbar spinal stenosis (LSS). Magnetic resonance imaging (MRI) and patient data were gathered from participants of a randomized trial.

Objective. It is believed that the narrowness of the lumbar spinal canal correlates to the severity of complaints and that it may be a good predictor of clinical outcome if treated. However, this hypothesis has never been (prospectively) tested.

Summary of Background Data. MRI is an important tool to confirm the diagnosis of LSS as a cause for intermittent neurogenic claudication.

Methods. Three raters were asked to evaluate the magnetic resonance images (Schizas scale). Symptom severities at baseline and 1-year follow-up were quantified. The radiological scores were correlated with clinical baseline and outcome scores to assess diagnostic and prognostic value of MRI findings at baseline.

Results. There was good agreement on the clinically relevant level of LSS (kappa range 0.57–0.64). MRI assessment of grading of compression (kappa 0.33–0.46) did not correlate with baseline MRDQ nor with outcome based on postoperative change in MRDQ (P = 0.61). However, both absence of epidural fat and presence of tortuous caudal nerves on magnetic resonance images (kappa 0.53–0.72 and 0.67–0.70) in patients with LSS were relatively good predictors for satisfactory recovery after surgery (P = 0.03 and P < 0.01).

Conclusion. The grading of compression on the preoperative MRI is neither ambiguous nor correlating to severity of clinical condition. It does, furthermore, not have the ability to predict the outcome after 1 year if surgically treated.

Level of Evidence: 2

Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands

Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands

Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands.

Address correspondence and reprint requests to Wouter A. Moojen, MD PhD, Medical Center Haaglanden, 2512 VA The Hague, South Holland, The Netherlands; E-mail:

Received 26 February, 2015

Revised 31 May, 2015

Accepted 1 July, 2015

The article submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants.

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