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JOURNAL OF NEUROSURGICAL SCIENCES

Rivista di Neurochirurgia


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Journal of Neurosurgical Sciences 2017 August;61(4):388-94

DOI: 10.23736/S0390-5616.16.02901-5

Copyright © 2014 EDIZIONI MINERVA MEDICA

lingua: Inglese

Decision-making process in patients with lumbar spinal canal stenosis

Parisa AZIMI 1, Hassan R., MOHAMMADI 1, Edward C. BENZEL 2, Shorab SHAHZADI 1, Shirzad AZHARI 1, Ali MONTAZERI 3

1 Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2 Cleveland Clinic Foundation, Department of Neurosurgery, Cleveland, OH, USA; 3 Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran


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BACKGROUND: The aim of this study was to develop a strategy to determine a sound methodology for decision-making in lumbar spinal canal stenosis (LSCS).
METHODS: This was a retrospective study of patients with LSCS to determine the rationale for those who underwent surgery and those who received conservative treatment. All case records were assessed to extract information on the morphology grade and dural sac cross-sectional surface area (DSCA) on MRI. Patients’ functionality and satisfaction were examined as outcome measures in order to understand factors that were associated with benefit from either treatment strategy.
RESULTS: In all 357 patients, case records were reviewed. The mean age of patients was 57.5 (SD=10.9) years. Of these, 176 patients underwent surgery. Post-treatment satisfaction was found in a large portion of the surgical group (93.2%) whereas this was 84.5% for those who received conservative treatment. Most patients (86.4%) who underwent surgery were identified as having grade C and grade D stenosis, while those who received conservative treatment were identified as having grade A and grade B stenosis (P<0.01). Overall satisfaction with surgery was found to be higher among patients with grade D stenosis (95%). Satisfaction by cross-sectional surface area did not show a consistent pattern. However, those with a cross-sectional surface area less than 100 mm2 benefited more from surgery. According to the findings, a decision matrix was proposed.
CONCLUSIONS: The findings suggest that the morphological grade and the DSCA jointly are useful parameters for helping clinicians to make clinically sound decisions in LSCS patients.


KEY WORDS: Decision making - Spinal canal - Lumbar stenosis, Familial

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Publication History

Issue published online: May 29, 2017
Article first published online: July 29, 2014
Manuscript accepted: July 16, 2014
Manuscript revised: June 30, 2014
Manuscript received: January 27, 2014

Per citare questo articolo

Azimi P, Mohammadi HR, Benzel EC, Shahzadi S, Azhari S, Montazeri A. Decision-making process in patients with lumbar spinal canal stenosis. J Neurosurg Sci 2017;61:388-94. DOI: 10.23736/S0390-5616.16.02901-5

Corresponding author e-mail

parisa.azimi@gmail.com