Decision making process in patients with lumbar spinal canal stenosis.

J Neurosurg Sci. 2014 Jul 29. [Epub ahead of print]


AIM:
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 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 cross--sectional surface area less than 100 mm2 benefited more from surgery. According to the findings, a decision matrix was proposed.

CONCLUSION:
The findings suggest that the morphological grade and the dural sac cross--sectional surface area (DSCA) jointly are useful parameters for helping clinicians to make clinically sound decisions in LSCS patients.