Correlation of lumbar lateral recess stenosis in magnetic resonance imaging and clinical symptoms

AIM To assess the correlation of lateral recess stenosis(LRS) of lumbar segments L4/5 and L5/S1 and the Oswestry Disability Index(ODI).METHODS Nine hundred and twenty-seven patients with history of low back pain were included in this uncontrolled study.On magnetic resonance images(MRI) the lateral recesses(LR) at lumbar levels L4/5 and L5/S1 were evaluated and each nerve root was classified into a 4-point grading scale(Grade 0-3) as normal,not deviated,deviated or compressed.Patient symptoms and disability were assessed using ODI.The Spearman's rank correlation coefficient was used for statistical analysis(P < 0.05).RESULTS Approximately half of the LR revealed stenosis(grade 1-3;52% at level L4/5 and 42% at level L5/S1) with 2.2% and 1.9% respectively reveal a nerve root compression.The ODI score ranged from 0%-91.11% with an arithmetic mean of 34.06% ± 16.89%.We observed a very weak statistically significant positive correlation between ODI and LRS at lumbar levels L4/5 and L5/S1,each bilaterally(L4/5 left:rho < 0.105,P < 0.01;L4/5 right:rho < 0.111,P < 0.01;L5/S1 left:rho 0.128,P < 0.01;L5/S1 right:rho < 0.157,P < 0.001).CONCLUSION Although MRI is the standard imaging tool for diagnosing lumbar spinal stenosis,this study showed only a weak correlation of LRS on MRI and clinical findings.This can be attributed to a number of reasons outlined in this study,underlining that imaging findings alone are not sufficient to establish a reliable diagnosis for patients with LRS.

Does therapist's attitude affect clinical outcome of lumbar facet joint injections?

AIM: To investigate if the clinical outcome of intraarticular lumbar facet joint injections is affected by the therapist's attitude. METHODS: A total of 40 patients with facet jointassociated chronic low back pain were randomly divided into two groups. All patients received computed tomography-guided, monosegmental intra-articular facet joint injections. Following the therapeutic procedure, the patients of the experimental group(EG) held a conversation with the radiologist in a comfortable atmosphere. During the dialog, the patients were encouraged to ask questions and were shown four images. The patients of the control group(CG) left the clinic without any further contact with the radiologist. Outcome was assessed using a pain-based Verbal Numeric Scale at baseline, at 1 wk and at 1, 3, and 6 mo after first treatment. RESULTS: The patient demographics showed no differences between the groups. The patients of the EG received 57 interventional procedures in total, while the patients of the CG received 70 interventional procedures. In both groups, the pain scores decreased significantly over the entire observation period. Compared to the CG, the EG showed a statistically significant reduction of pain at 1 wk and 1 mo post-treatment, while at 3 and 6 mo after treatment, there were no significant differences between both groups. CONCLUSION: Our results show a significant effect on pain relief during the early post-interventional period in the EG as compared to the CG. The basic principle behind the higher efficacy might be the phenomenon of hetero-suggestion.

Definition of retrosternal thyroid growth

The diagnosis of a retrosternal thyroid growth (RTG) causes extended surgical exploration and a different surgical treatment planning (partial sternotomy, thoracotomy) and is usually made by the help of thyroid scintigraphy and ultrasonography. But both examinations have problems in determining the retrosternal thyroid extend in the complex anatomy of sternal bone and often pathologically altered manubrioclavicular joints (MCJ). This study evaluates the variation of anatomical structures in the upper sternal region, the position of the sternal markers during scintigraphy, and the frequency of enhanced bone metabolism of the MCJs. For this aim, the positions of the upper edges of the MCJs were measured by X-ray fluoroscopy in 50 consecutive patients. To prove the exactness of an external marker as used in thyroid scintigraphy, the variation of the marker position was also determined. The activity in the MCJs was measured semiquantitatively with bone scintigraphy in further 100 patients (mean age: 62.3 yrs, SD: 14.2 yrs). As results, the upper edges of the medial clavicular edges exceed the upper margin of the sternal edge up to 2.7 cm. The distance between the medial clavicular edges ranged from 2.3 - 5.6 cm. The position of the sternal marker was correct in the horizontal deviation (mean: 0.1 cm, SD: 0.48 cm) but too high in the vertical position (mean: 2.2 cm, SD: 0.67 cm). During bone scintigraphy, the MCJs showed no enhanced activitity in 75/200 joints, medium activity in 96/200 joints, and strong enhanced activity in 29/200 joints. In consequence, a high variability in the position of the anatomical structures has to be considered together with a high amount of degenerative alterations. The position of the sternal marker was inappropriate in the vertical direction and overestimated a possible retrosternal growth.