Correlation between lumbar spinal stenosis based on morphology of the dural sac and the quality of life / Correlação entre estenose lombar baseada na morfologia do saco dural e qualidade de vida / Correlación entre estenosis lumbar basada en la morfología del saco dural y la calidad de vida

ABSTRACT Objective: To evaluate the possible existence of a significant correlation between quality of life and severity classification of lumbar stenosis based on dural sac morphology in outpatients. Methods: Forty patients with a diagnosis of lumbar stenosis followed at a university hospital were submitted to magnetic resonance imaging (MRI) and quality of life questionnaires: Oswestry Disability Index (ODI), SF-36, Swiss Spinal Stenosis Questionnaire (SSS) and EQ-5D. They were classified as type A, B, C or D based on MRI. For the statistical analysis, the Spearman correlation was used. Results: Seventeen female patients and 23 male patients with mean age of 56.5 years constituted the sample. ODI had a mean dysfunction of 44.9%, the PCS score averaged 29.9, the MCS score was 41.3. The general symptoms of SSS presented a mean of 3.2 and the EQ-5D presented an average of 0.491. The patients with the highest severity in the classification were not necessarily those who presented worse scores in the quality of life questionnaires. Conclusion: The classification of severity of the lumbar spinal stenosis based on dural sac morphology does not correlate with the applied quality of life questionnaires. Level of Evidence III; Cross-sectional observational study.

RESUMO Objetivo: Avaliar a possível existência de uma correlação significativa entre a classificação de gravidade da estenose lombar baseada na morfologia do saco dural e a qualidade de vida em pacientes ambulatoriais. Método: Quarenta pacientes com diagnóstico de estenose lombar, acompanhados em um hospital universitário, foram submetidos ao exame de Ressonância Magnética (RM) e a questionários de qualidade de vida: Oswestry Disability Index (ODI), SF-36, Swiss Spinal Stenosis Questionnaire (SSS) e EQ-5D. Foram classificados em tipo A, B, C ou D, baseados na RM. Na análise estatística, foi realizada a correlação de Spearman. Resultados: 17 pacientes do sexo feminino e 23 do sexo masculino com média de idade de 56,5 anos. ODI apresentou uma disfunção média de 44,9%, o PCS escore médio de 29,9, o MCS de 41,3. Os Sintomas gerais do SSS apresentaram média de 3,2 e o EQ-5D apresentou média de 0,491. Os pacientes com maior gravidade da classificação não foram, necessariamente, os que apresentaram piores escores nos questionários de qualidade de vida. Conclusão: Classificação de estenose lombar baseada na morfologia do saco dural não apresenta correlação com os questionários de qualidade de vida aplicados. Nível de Evidência III; Estudo observacional analítico transversal.

RESUMEN Objetivo: Evaluar la posible existencia de una correlación significativa entre la calidad de vida y la clasificación de la gravedad de la estenosis lumbar basada en la morfología del saco dural en pacientes ambulatorios. Métodos: Cuarenta pacientes con diagnóstico de estenosis lumbar seguidos en un hospital universitario fueron sometidos a resonancia magnética (RM) y a cuestionarios de calidad de vida: Índice de Discapacidad de Oswestry (ODI), SF-36, Swiss Spinal Stenosis Questionnaire (SSS) y EQ-5D. Se clasificaron como tipo A, B, C o D según la resonancia magnética. Para el análisis estadístico, se utilizó la correlación de Spearman. Resultados: Diecisiete pacientes del sexo femenino y 23 del sexo masculino con una edad promedio de 56,5 años constituyeron la muestra. El ODI tuvo una disfunción promedio de 44,9%, la puntuación PCS fue en media 29,9, la puntuación MCS fue de 41,3. Los síntomas generales de SSS presentaron una media de 3,2 y el EQ-5D presentó una media de 0,491. Los pacientes con mayor gravedad en la clasificación no fueron necesariamente los que presentaron puntuaciones peores en los cuestionarios de calidad de vida. Conclusión: La clasificación de la gravedad de la estenosis lumbar basada en la morfología del saco dural no se correlaciona a los cuestionarios de calidad de vida aplicados. Nivel de evidencia III; Estudio observacional analítico transversal.

Application of Spatial Modulation of Magnetization to Cervical Spinal Stenosis for Evaluation of the Hydrodynamic Changes Occurring in Cerebrospinal Fluid

OBJECTIVE: To evaluate the hydrodynamic changes occurring in cerebrospinal fluid (CSF) flow in cervical spinal stenosis using the spatial modulation of magnetization (SPAMM) technique. MATERIALS AND METHODS: Using the SPAMM technique, 44 patients with cervical spinal stenosis and ten healthy volunteers were investigated. The degree of cervical spinal stenosis was rated as low-, intermediate-, or high-grade. Low-grade stenosis was defined as involving no effacement of the subarachnoid space, intermediate-grade as involving effacement of this space, and high-grade as involving effacement of this space, together with compressive myelopathy. The patterns of SPAMM stripes and CSF velocity were evaluated and compared between each type of spinal stenosis and normal spine. RESULTS: Low-grade stenosis (n = 23) revealed displacement or discontinuity of stripes, while intermediate- (n = 10) and high-grade (n = 11) showed a continuous straight band at the stenotic segment. Among low-grade cases, 12 showed wave separation during the systolic phase. Peak systolic CSF velocity at C4 -5 level in these cases was lower than in volunteers (p .05). In high-grade stenosis, both diastolic and systolic velocities were significantly lower (p <.05). CONCLUSION: Various hydrodynamic changes occurring in CSF flow in cervical spinal stenosis were demonstrated by the SPAMM technique, and this may be a useful method for evaluating CSF hydrodynamic change in cervical spinal stenosis.