Redefining lumbar spinal stenosis as a developmental syndrome: does age matter?

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OBJECTIVE

Age is commonly thought to be a risk factor in defining lumbar spinal stenosis (LSS) degenerative or developmental subtypes. This article is a follow-up to a previous article (“Redefining Lumbar Spinal Stenosis as a Developmental Syndrome: An MRI-Based Multivariate Analysis of Findings in 709 Patients Throughout the 16- to 82-Year Age Spectrum”) that describes the radiological differences between developmental and degenerative types of LSS. MRI-based analysis of “degeneration” variables and spinal canal morphometric characteristics of LSS segments have been thought to correlate with age at presentation.

METHODS

The authors performed a re-analysis of data from their previously reported prospective MRI-based study, stratifying data from the 709 cases into 3 age categories of equal size (instead of the original < 60 vs ≥ 60 years). Relative spinal canal dimensions, as well as radiological degenerative variables from L1 to S1, were analyzed across age groups in a multivariate mode. The total degenerative scale score (TDSS) for each lumbar segment from L1 to S1 was calculated for each patient. The relationships between age and qualitative stenosis grades, TDSS, disc degeneration, and facet degeneration were analyzed using Pearson’s product-moment correlation and multiple regression.

RESULTS

Multivariate analysis of TDSS and spinal canal dimensions revealed highly significant differences across the 3 age groups at L2–3 and L3–4 and a weaker, but still significant, association with changes at L5–S1. Age helped to explain only 9.6% and 12.2% of the variance in TDSS at L1–2 and L2–3, respectively, with a moderate positive correlation, and 7.8%, 1.2%, and 1.9% of the variance in TDSS at L3–4, L4–5, and L5–S1, respectively, with weak positive correlation. Age explained 24%, 26%, and 18.4% of the variance in lumbar intervertebral disc (LID) degeneration at L1–2, L2–3, and L3–4, respectively, while it explained only 6.2% and 7.2% of the variance of LID degeneration at L4–5 and L5–S1, respectively. Age explained only 2.5%, 4.0%, 1.2%, 0.8%, and 0.8% of the variance in facet degeneration at L1–2, L2–3, L3–4, L4–5, and L5–S1, respectively.

CONCLUSIONS

Age at presentation correlated weakly with degeneration variables and spinal canal morphometries in LSS segments. Age correlated with upper lumbar segment (L1–4) degeneration more than with lower segment (L4–S1) degeneration. The actual chronological age of the patients did not significantly correlate with the extent of degenerative pathology of the lumbar stenosis segments. These study results lend support for a developmental contribution to LSS.

ABBREVIATIONS LID = lumbar intervertebral disc; LSS = lumbar spinal stenosis; TDSS = total degenerative scale score.

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Article Information

Correspondence Edward C. Benzel: Cleveland Clinic, Center for Spine Health, Cleveland, OH. benzele@ccf.org.

INCLUDE WHEN CITING Published online May 17, 2019; DOI: 10.3171/2019.2.SPINE181383.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    A–D: Midsagittal and axial T2-weighted MR images obtained in a 28-year-old man with left leg claudication sciatic pain (8 years’ time difference between A and B). E and F: Midsagittal and axial T2-weighted MR images obtained at L3–4 in a 40-year-old man with bilateral claudication sciatic pain and weakness, respectively. G and H: Midsagittal and axial T2-weighted MR images obtained in a 76-year-old woman with disabling claudication leg pain, respectively.

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    Axial T2-weighted MR images detailing the lumbar spinal canal variables tested. A: Anteroposterior spinal canal length (APCa) and anteroposterior vertebral body length (APB). B: Transverse spinal canal width (TCW) and transverse vertebral body width (TBW). C: Spinal canal cross-sectional area (CCSA) and vertebral body cross-sectional area (BCSA). D: Facet inclination angle. E: Interlaminar angle. F: Thecal sac cross-sectional area (TCSA) and spinal canal cross-sectional area (CCSA).

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    Sagittal T2-weighted MR image showing the anteroposterior spinal canal diameter (APC)/anteroposterior vertebral body diameter (APB) measurements.

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    Distribution of stenosis by age group across the lumbosacral levels.

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