Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

The Relationship between Neural Foraminal Stenosis and Imaging Features of Lumbar Spine MRI in Patients Older Than 60 Years with Lumbar Radiculopathy

요추신경근병증이 있는 60세 이상의 환자에서 신경공 협착과 자기공명영상 평가를 통한 인자와의 상관관계

  • Kyeyoung Lee (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Hee Seok Jeong (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Chankue Park (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Maeran Kim (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Hwaseong Ryu (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Jieun Roh (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Jeong A Yeom (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Jin Hyeok Kim (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Tae Un Kim (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Chang Ho Jeon (Department of Radiology, Pusan National University Hospital)
  • 이계영 (양산부산대학교병원 영상의학과) ;
  • 정희석 (양산부산대학교병원 영상의학과) ;
  • 박찬규 (양산부산대학교병원 영상의학과) ;
  • 김매란 (양산부산대학교병원 영상의학과) ;
  • 류화성 (양산부산대학교병원 영상의학과) ;
  • 노지은 (양산부산대학교병원 영상의학과) ;
  • 염정아 (양산부산대학교병원 영상의학과) ;
  • 김진혁 (양산부산대학교병원 영상의학과) ;
  • 김태언 (양산부산대학교병원 영상의학과) ;
  • 전창호 (부산대학교병원 영상의학과)
  • Received : 2020.05.15
  • Accepted : 2020.10.06
  • Published : 2021.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose To investigate the MRI features associated with neural foraminal stenosis (NFS) in patients older than 60 years with lumbar (L) radiculopathy. Materials and Methods This study included 133 retrospectively selected patients older than 60 years with lumbar radiculopathy who had undergone a lumbar spine MRI (from January 2018 to April 2018). For L4/L5 and L5/sacral (S)1 levels, NFS was reviewed blindly by two radiologists. Spondylolisthesis, retrolisthesis, disc height loss, disc bulging/herniation/central canal stenosis, ligamentum flavum thickening, and facet hypertrophy were evaluated separately for the NFS and non-NFS groups, and they were compared using univariate and multivariate analyses. Results The univariate analysis revealed that disc height loss (p = 0.006) was associated with NFS for L4/L5. For L5/S1, both spondylolisthesis (p = 0.005) and facet hypertrophy (p = 0.006) were associated with NFS. The multivariate logistic analysis revealed that disc height loss was associated with NFS for L4/L5 [odds ratio (OR) = 4.272; 95% confidence interval (CI) 1.736-10.514]. For L5/S1, spondylolisthesis (OR = 3.696; 95% CI 1.297-10.530) and facet hypertrophy (OR = 6.468; 95% CI 1.283-32.617) were associated with NFS. Conclusion Disc height loss was associated with NFS for L4/L5 and spondylolisthesis and facet hypertrophy were associated with NFS for L5/S1.

목적 요추신경근병증이 있는 60세 이상의 환자의 신경공 협착에 영향을 줄 수 있는 인자를 자기공명영상 평가를 통해 알아보고자 하였다. 대상과 방법 요추신경근병증이 있는 60세 이상의 환자 133명이 본원에서 시행 받은 2018년 1월부터 4월까지의 요추 자기공명영상을 대상으로 하였다. 제4/5 요추간과 제5 요추/제1 천추간에서 신경공 협착이 있는 군과 없는 군으로 나눈 후 척추전방전위증, 척추후방전위증, 추간판 간격 감소, 추간판탈출증, 중심성 척추관 협착, 황색인대비후, 척추후관절 비후 여부를 2명의 판독자가 분석한 후 단변량 및 다변량 로지스틱 회귀분석을 시행하였다. 결과 단변량 분석에서 제4/5 요추간에 대해 추간판 간격 감소(p = 0.006), 제5 요추/제1 천추간에 대해서는 척추전방전위증(p = 0.005)과 척추후관절 비후(p = 0.006)가 신경공 협착과 유의한 연관성을 보였다. 다변량 분석에서는 제4/5 요추간에 대해 추간판 간격 감소[odds ratio(이하 OR) = 4.272; 95% confidence interval (이하 CI) 1.736~10.514]가 신경공 협착과 관련된 인자였다. 제5 요추/제1 천추간에서는 척추전방전위증(OR = 3.696; 95% CI 1.297~10.530)과 척추후관절 비후(OR = 6.468; 95% CI 1.238~32.617)가 이와 관련된 인자였다. 결론 제4/5 요추간에서는 추간판 간격 감소가, 제5 요추/제1 천추간에서는 척추전방전위증과 척추후관절 비후가 신경공 협착과 관련된 인자였다.

Keywords

Acknowledgement

This work was supported by clinical research grant from Pusan National University Yangsan Hospital in 2020.

References

  1. Hasegawa T, An HS, Haughton VM, Nowicki BH. Lumbar foraminal stenosis: critical heights of the intervertebral discs and foramina. A cryomicrotome study in cadavera. J Bone Joint Surg Am 1995;77:32-38 
  2. Lee S, Lee JW, Yeom JS, Kim KJ, Kim HJ, Chung SK, et al. A practical MRI grading system for lumbar foraminal stenosis. AJR Am J Roentgenol 2010;194:1095-1098 
  3. Evans N, McCarthy M. Management of symptomatic degenerative low-grade lumbar spondylolisthesis. EFORT Open Rev 2018;3:620-631 
  4. Saleem S, Aslam HM, Rehmani MA, Raees A, Alvi AA, Ashraf J. Lumbar disc degenerative disease: disc degeneration symptoms and magnetic resonance image findings. Asian Spine J 2013;7:322-334 
  5. Jeong HY, You JW, Sohn HM, Park SH. Radiologic evaluation of degeneration in isthmic and degenerative spondylolisthesis. Asian Spine J 2013;7:25-33 
  6. Ong A, Anderson J, Roche J. A pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic Games. Br J Sports Med 2003;37:263-266 
  7. Perera RS, Dissanayake PH, Senarath U, Wijayaratne LS, Karunanayake AL, Dissanayake VHW. Associations between disc space narrowing, anterior osteophytes and disability in chronic mechanical low back pain: a cross sectional study. BMC Musculoskelet Disord 2017;18:193 
  8. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 2001;26:1873-1878 
  9. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994;331:69-73 
  10. Van Rijn JC, Klemetso N, Reitsma JB, Majoie CB, Hulsmans FJ, Peul WC, et al. Observer variation in MRI evaluation of patients suspected of lumbar disk herniation. AJR Am J Roentgenol 2005;184:299-303 
  11. Lee GY, Lee JW, Choi HS, Oh KJ, Kang HS. A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skeletal Radiol 2011;40:1033-1039 
  12. Chokshi FH, Quencer RM, Smoker WR. The "thickened" ligamentum flavum: is it buckling or enlargement? AJNR Am J Neuroradiol 2010;31:1813-1816 
  13. Safak AA, Is M, Sevinc O, Barut C, Eryoruk N, Erdogmus B, et al. The thickness of the ligamentum flavum in relation to age and gender. Clin Anat 2010;23:79-83 
  14. An SJ, Seo MS, Choi SI, Lim TH, Shin SJ, Kang KN, et al. Facet joint hypertrophy is a misnomer: a retrospective study. Medicine (Baltimore) 2018;97:e11090 
  15. Pathria M, Sartoris DJ, Resnick D. Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology 1987;164:227-230 
  16. Lee KS, Moon MS, Lee WC. Clinical evaluation of degenerative spondylolisthesis. J Korean Orthop Assoc 1984;19:640-648 
  17. Rissanen PM. Comparison of pathologic changes in intervertebral discs and interspinous ligaments of the lower part of the lumbar spine in the light of autopsy findings. Acta Orthop Scand 1964;34:54-65 
  18. Lyons G, Eisenstein SM, Sweet MB. Biochemical changes in intervertebral disc degeneration. Biochim Biophys Acta 1981;673:443-453 
  19. Urban JP, Roberts S. Degeneration of the intervertebral disc. Arthritis Res Ther 2003;5:120-130 
  20. Jeon I, Kim SW. Retrolisthesis as a compensatory mechanism in degenerative lumbar spine. J Korean Neurosurg Soc 2015;57:178-184 
  21. Shipley JA. Lumbar spinal stenosis. SA Orthopaedic Journal 2008;7:42-49 
  22. MacMahon PJ, Taylor DH, Duke D, Brennan DD, Eustace SJ. Disc displacement patterns in lumbar anterior spondylolisthesis: contribution to foraminal stenosis. Eur J Radiol 2009;70:149-154 
  23. Kim JS, Kang HS, Yoon HK, Kim CW. Mr findings of spondylolisthesis: assessment of associated spinal and neural foraminal stenosis. J Korean Radiol Soc 1994;30:361-367 
  24. Choi YK. Lumbar foraminal neuropathy: an update on non-surgical management. Korean J Pain 2019;32:147-159