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Open Access Research article

Correlation of lateral stenosis in MRI with symptoms, walking capacity and EMG findings in patients with surgically confirmed lateral lumbar spinal canal stenosis

Pekka Kuittinen1*, Petri Sipola23, Timo Juhani Aalto4, Sara Määttä56, Anita Parviainen7, Tapani Saari3, Sanna Sinikallio8, Sakari Savolainen1, Veli Turunen9, Heikki Kröger109, Olavi Airaksinen11 and Ville Leinonen1

Author Affiliations

1 Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland

2 Department of Clinical Radiology, University of Eastern Finland, Kuopio, Finland

3 Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland

4 Kyyhkylä Rehabilitation Center and Hospital, Mikkeli, Finland

5 Department of Clinical Neurophysiology, University of Eastern Finland, Kuopio, Finland

6 Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland

7 Department of Clinical Neurophysiology, North Karelia Central Hospital, Joensuu, Finland

8 University of Eastern Finland, Institute of Public Health and Clinical Nutrition, Kuopio, Finland

9 Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland

10 Bone and Cartilage Research Unit, University of Eastern Finland, Kuopio, Finland

11 Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland

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BMC Musculoskeletal Disorders 2014, 15:247  doi:10.1186/1471-2474-15-247

Published: 23 July 2014

Abstract

Background

To evaluate the clinical significance of lateral lumbar spinal canal stenosis (LLSCS), found by magnetic resonance imaging (MRI), through correlating the imaging findings with patient symptoms, walking capacity and electromyography (EMG) measurements.

Method

102 patients with symptoms of LSS referred for operative treatment were studied in this uncontrolled study. Of these patients, subjects with distinct only lateral LSS were included. Accordingly, 140 roots in 14 patients (mean age 58, range 48-76 years, male 43%) were evaluated. In MR images the entrance and mid zones of the lateral lumbar nerve root canal were graded as normal, narrowed but not compressed, or compressed. In quantitative analysis, the minimal widths of the lateral recess and mid zone area were measured. Clinical symptoms were recorded with the Oswestry Disability Index (ODI), overall Visual Analogue Scale (VAS), specific low back pain (LBP; NRS-11), specific leg pain (LP NRS-11), Beck Depression Inventory (BDI) and walking distance in the treadmill test. Lumbar paraspinal (L2- L5) and lower limb (L3 – S1) needle EMG studies were performed. The findings were classified root by root as 1 = normal, 2 = abnormal. The associations between radiological, EMG and clinical findings were tested with each other.

Results

EMG findings were normal in 92 roots and abnormal in 48 roots. All of the patients had at least one abnormal nerve root finding. Severity of the mid zone stenosis in MRI correlated with abnormal EMG findings (p = 0.015). Patients with abnormal EMG had also higher scores in the VAS (41.9 ± 25.7 vs 31.5 ± 18.1; p = 0.018), NRS leg pain (7.5 ± 1.5 vs 6.3 ± 2.1; p = 0.000) and BDI (9.8 ± 3.8 vs 8.0 ± 3.9; p = 0.014). However, no statistically significant correlations between MRI findings and clinical symptoms or walking capacity were found.

Conclusions

Among persons previously selected for surgery, lateral stenosis seen on MRI correlates with EMG, and thus may be a clinically significant finding. Our EMG findings were also associated with patient symptoms. However, no relationships between the MRI findings and symptoms or walking capacity were found, suggesting their multifactorial etiology.