Gagen, Richard (2021) The value of magnetic resonance imaging in the assessment of degenerative lumbar spinal stenosis. PhD thesis, University of Warwick.

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Abstract

This thesis explores the role of magnetic resonance imaging (MRI) of the lumbar spine in patients with the main clinical feature of lumbar spinal stenosis (LSS): neurogenic claudication (NC). NC is thought to be caused by positional compression of the cauda equina in a spinal canal narrowed by degenerative change. MRI is the primary tool for demonstrating such degeneration but no universally accepted and evidence based imaging definition of LSS exists.

Systematic reviews of the literature are presented: the first finds the available studies comparing MRIs in NC patients to a control group have unsuitable methodologies to propose a definition of stenosis, largely due to use of imaging based inclusion criteria. The second finds the strength of relationship between canal size and symptom severity in LSS patients is inconsistent across different studies, but with most papers using surgical patient cohorts, likely to exclude those with minor symptoms.

A diagnostic cross-sectional study, including both community and secondary care based participants is described, comparing MRIs in participants with NC and a separately recruited control group. Unlike prior studies, NC patients are selected for inclusion based upon their clinical presentation alone. NC patients are found to have smaller canals than the control group, but measurements of canal narrowing or qualitative judgement of nerve root compression generally fail to accurately predict NC symptoms, and various methods of combining the measurements, including machine learning techniques, fail to improve diagnostic accuracy. No convincing relationship between symptom severity and canal size is identified.

A definition for radiological LSS is proposed for the central canal (grade C — Schizas et al. 2010) the lateral recess (grade 2 nerve root entrapment – Bartynski et al. 2003), and the neural exit foramen (neural exit foramen depth less than 4 mm) based upon the best performing measurements and other pragmatic considerations.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RC Internal medicine R Medicine > RD Surgery
Library of Congress Subject Headings (LCSH):	Spinal canal -- Stenosis -- Magnetic resonance imaging, Spinal canal -- Diseases -- Magnetic resonance imaging, Lumbar vertebrae -- Magnetic resonance imaging, Magnetic resonance imaging
Official Date:	9 July 2021
Dates:	Date Event 9 July 2021 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Hutchinson, Charles ; Parsons, Caron
Sponsors:	National Institute of Health Research (Great Britain)
Format of File:	pdf
Extent:	xx, 187 leaves : illustrations
Language:	eng

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