Redundant nerve roots in lumbar spinal stenosis: inter- and intra-rater reliability of an MRI-based classification.

PURPOSE: Patients with central lumbar spinal stenosis (LSS) have a longer symptom history, more severe stenosis, and worse postoperative outcomes, when redundant nerve roots (RNRs) are evident in the preoperative MRI. The objective was to test the inter- and intra-rater reliability of an MRI-based classification for RNR. METHODS: This is a retrospective reliability study. A neuroradiologist, an orthopedic surgeon, a neurosurgeon, and three orthopedic surgeons in-training classified RNR on 126 preoperative MRIs of patients with LSS admitted for microsurgical decompression. On sagittal and axial T2-weighted images, the following four categories were classified: allocation (A) of the key stenotic level, shape (S), extension (E), and direction (D) of the RNR. A second read with cases ordered differently was performed 4 weeks later. Fleiss and Cohen's kappa procedures were used to determine reliability. RESULTS: The allocation, shape, extension, and direction (ASED) classification showed moderate to almost perfect inter-rater reliability, with kappa values (95% CI) of 0.86 (0.83, 0.90), 0.62 (0.57, 0.66), 0.56 (0.51, 0.60), and 0.66 (0.63, 0.70) for allocation, shape, extension, and direction, respectively. Intra-rater reliability was almost perfect, with kappa values of 0.90 (0.88, 0.92), 0.86 (0.84, 0.88), and 0.84 (0.81, 0.87) for shape, extension, and direction, respectively. Intra-rater kappa values were similar for junior and senior raters. Kappa values for inter-rater reliability were similar between the first and second reads (p = 0.06) among junior raters and improved among senior raters (p = 0.008). CONCLUSIONS: The MRI-based classification of RNR showed moderate-to-almost perfect inter-rater and almost perfect intra-rater reliability.

[Classification and diagnosis of lumbar spinal stenosis]. / Klassifikation und Diagnostik der lumbalen Spinalkanalstenose.

BACKGROUND: Lumbar spinal stenosis is caused by various pathological conditions. With the diagnostic tools available, a precise classification of the condition should be made, which enables a consistent and appropriate therapeutic approach. OBJECTIVES: In the present article, the currently used classifications of lumbar spinal stenosis are discussed and the diagnostic tools are presented, focussing on the imaging descriptions of morphological changes. MATERIALS AND METHODS: This article is based on a PubMed literature search of the past 60 years and our own experiences. RESULTS: Lumbar spinal stenosis is caused mainly by degenerative changes to the spine. MR tomographic imaging can result in precise anatomical illustration and classification of the stenosis. CONCLUSIONS: Although modern imaging procedures deliver a very precise illustration of lumbar spinal stenosis, clinical symptoms make a considerable contribution to therapeutic decision-making. With the anatomical classification, differentiated surgical decompression of the spinal canal can be planned.

Texture analysis of paraspinal musculature in MRI of the lumbar spine: analysis of the lumbar stenosis outcome study (LSOS) data.

OBJECTIVE: To evaluate association of fatty infiltration in paraspinal musculature with clinical outcomes in patients suffering from lumbar spinal stenosis (LSS) using qualitative and quantitative grading in magnetic resonance imaging (MRI). MATERIALS AND METHODS: In this retrospective study, texture analysis (TA) was performed on postprocessed axial T2 weighted (w) MR images at level L3/4 using dedicated software (MaZda) in 62 patients with LSS. Associations in fatty infiltration between qualitative Goutallier and quantitative TA findings with two clinical outcome measures, Spinal stenosis measure (SSM) score and walking distance, at baseline and regarding change over time were assessed using machine learning algorithms and multiple logistic regression models. RESULTS: Quantitative assessment of fatty infiltration using the histogram TA feature "mean" showed higher interreader reliability (ICC 0.83-0.97) compared to the Goutallier staging (κ = 0.69-0.93). No correlation between Goutallier staging and clinical outcome measures was observed. Among 151 TA features, only TA feature "mean" of the spinotransverse group showed a significant but weak correlation with worsened SSM (p = 0.046). TA feature "S(3,3) entropy" showed a significant but weak association with worsened WD over 12 months (p = 0.046). CONCLUSION: MR TA is a reproducible tool to quantitatively assess paraspinal fatty infiltration, but there is no clear association with the clinical outcome in asymptomatic LSS patients.

Decompressive surgery for lumbar spinal stenosis across the Atlantic: a comparison of preoperative MRI between matched cohorts from the US and Norway.

BACKGROUND: There are no uniform guidelines regarding when to operate for Lumbar Spinal Stenosis (LSS). As we apply findings from clinical research from one population to the next, elucidating similarities or differences provides important context for the validity of extrapolating clinical outcomes. The aim of this study was to compare the morphological severity of lumbar spinal stenosis on preoperative MRI in patients undergoing decompressive surgery in Boston, USA, and Trondheim, Norway. METHODS: In this observational retrospective study, we compared morphological severity on MRI before surgical treatment between two propensity score-matched patient populations with single or two-level symptomatic LSS. We assessed the radiographic severity of LSS utilizing the Schizas classification (grade A to D). RESULTS: Following propensity score matching, demographics are balanced. In the Trondheim cohort, two levels decompression were present in 36.2% of the patients vs. 41.9% in Boston, (p = 0.396). There was no significant difference in grades A to D concerning central stenosis (p = 0.075). When dichotomized in mild/moderate (A/B) and severe /extreme (C/D), there were no significant differences in the rate of levels operated for high-grade stenosis (C/D), 67.6% in the Boston group compare to 78.1% in the Trondheim group (p = 0.088). CONCLUSIONS: Trondheim, Norway, and Boston, US, have similar radiographic thresholds of LSS for offering surgery.

A novel MRI classification system for congenital functional lumbar spinal stenosis predicts the risk for tandem cervical spinal stenosis.

PURPOSE: The purpose of this study was to develop a simple and clinically useful morphological classification system for congenital lumbar spinal stenosis using sagittal MRI, allowing clinicians to recognize patterns of lumbar congenital stenosis quickly and be able to screen these patients for tandem cervical stenosis. METHODS: Forty-four subjects with an MRI of both the cervical and lumbar spine were included. On the lumbar spine MRI, the sagittal canal morphology was classified as one of three types: Type I normal, Type II partially narrow, Type III globally narrow. For the cervical spine, the Torg-Pavlov ratio on X-ray and the cervical spinal canal width on MRI were measured. Kruskal-Wallis analysis was done to determine if there was a relationship between the sagittal morphology of the lumbar spinal canal and the presence of cervical spinal stenosis. RESULTS: Subjects with a type III globally narrow lumbar spinal canal had a significantly lower cervical Torg-Pavlov ratio and smaller cervical spinal canal width than those with a type I normal lumbar spinal canal. CONCLUSION: A type III lumbar spinal canal is a globally narrow canal characterized by a lack of spinal fluid around the conus. This was defined as "functional lumbar spinal stenosis" and is associated with an increased incidence of tandem cervical spinal stenosis.

Comparison of inter- and intra-observer reliability among the three classification systems for cervical spinal canal stenosis.

PURPOSE: The aim is to analyze the agreement between different types of physicians in terms of the inter-observer and intra-observer reliability in addition to the agreement between the experienced and non-experienced physicians with respect to three different classification systems for diagnosis of cervical spinal canal stenosis. METHODS: Total nine doctors including experienced group of three doctors and non-experienced group of six doctors classified the patients according to three different classification in an independent, blinded manner using magnetic resonance imaging (MRI) to diagnose cervical canal stenosis. MRI slice included sagittal plane (midline cut) and an image slice from each horizontal plane that penetrated the right center of each disk (C3-4, C4-5, C5-6, and C6-7) was made by PPT format. RESULTS: For the inter-observer reliability, Vaccaro et al.'s classification system showed the excellent reproducibility, followed by Muhle et al. and Kang et al. All three classification systems showed excellent reproducibility and substantial agreement in terms of the intra-observer reliability. CONCLUSIONS: All three classification systems showed excellent reproducibility and also displayed a substantial agreement. The classification system used by Vaccaro et al. was proven to be a method with substantial agreement both in the experienced group and the non-experienced group. It can be a useful classification system for simplifying communication among all physicians.

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews.

BACKGROUND: Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization. METHODS: A sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR. RESULTS: Sixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making. CONCLUSIONS: This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed.

Clinical outcome of lumbar spinal stenosis based on new classification according to hypertrophied ligamentum flavum.

BACKGROUND: The ligamentum flavum hypertrophy is considered to be one of the important causes of development of lumbar spinal stenosis (LSS). Several histologic and biologic mechanisms in hypertrophied flavum have proposed. However, no study that investigated the relationship between clinical outcome and ligamentum flavum hypertrophy has been published. The purpose of this study was to identify a new classification of LSS, in ligamentous and nonligamentous stenosis, according to the cutoff value of the area proportion of the ligamentum flavum in the spinal canal, and to assess the value of surgical and conservative treatments for LSS based on the classification of the ligamentous stenosis. METHODS: A total of 230 surgical patients with LSS were evaluated based on the cross-sectional area and intraoperative findings of the ligamentum flavum. LSS was classified as ligamentous or nonligamentous stenosis, according to the cutoff value of the proportion of the ligamentum flavum in the spinal canal. Based on the classification, the results of 234 surgical patients (103 patients with spinal fusion surgery and 131 patients with spinal decompression) and 191 patients under conservative treatment with prostaglandin E1 were evaluated, 1 year after treatments. RESULTS: ROC analysis revealed that the area under the curve for the cutoff value of the proportion of the ligamentum flavum in the spinal canal was 0.4275 (sensitivity = 0.861, specificity = 0.854). Based on these criteria, ligamentous and nonligamentous stenoses were 115 and 119 in surgical patients, 97 and 94 in conservative patients, respectively. In the surgical treatment group, no significant difference was found in any of the evaluations conducted for the group with ligamentous and nonligamentous stenosis. However, in the conservative treatment group, the patients with ligamentous stenosis showed significant improvement compared with patients with nonligamentous stenosis. CONCLUSIONS: Ligamentous stenosis in LSS patients had favorable outcome on conservative treatment with prostaglandin E1 derivative.

Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis.

PURPOSE: We aimed to study the relationship between two morphological parameters recently described on MRI images in relation to lumbar spinal stenosis (LSS): the first is the sedimentation sign (SedS) and the second is the morphological grading of lumbar stenosis. MATERIALS AND METHODS: MRIs from a total of 137 patients were studied. From those, 110 were issued from a prospective database of symptomatic LSS patients, of whom 73 were treated surgically and 37 conservatively based on symptom severity. A third group consisting of 27 subjects complaining of low back pain (LBP) served as control. Severity of stenosis was judged at disc level using the four A to D grade morphological classification. The presence of a SedS was judged at pedicle level, above or below the site of maximal stenosis. RESULTS: A positive SedS was observed in 58, 69 and 76% of patients demonstrating B, C and D morphology, respectively, but in none with grade A morphology. The SedS was positive in 67 and 35% of the surgically and conservatively treated patients, respectively, and in 8% of the LBP group. C and D morphological grades were present in 97 and 35% of patients in the surgically and conservatively treated group, respectively, and in 18% of the LBP group. Presence of a positive SedS carried an increased risk of being submitted to surgery in the symptomatic LSS group (OR 3.5). This risk was even higher in the LSS patients demonstrating grade C or D morphology (OR 65). DISCUSSION AND CONCLUSION: One-third of surgically treated LSS patients do not present a SedS. This sign appears to be a lesser predictor of treatment modality in our setting of symptomatic LSS patients compared to the severity of stenosis judged by the morphological grade.

Measurements and classifications in spine imaging.

Imaging criteria and radiologic measurements play a key role in the diagnosis of spinal diseases. In addition, they often create the basis of classification systems that determine the severity of the disease and thereby enable a stage-related therapy. A clearly defined nomenclature for imaging findings as well as standardized and thoroughly evaluated methods of measurement are necessary to achieve a sufficiently high diagnostic accuracy. Various specialized committees dealing with the diagnosis of spinal diseases have made efforts within the last years to develop diagnostic standards. This review provides an overview of radiologic measurements and classification systems that are currently used for the diagnosis of scoliosis and degenerative diseases of the lumbar spine.

MRI evaluation of lumbar spinal stenosis: is a rapid visual assessment as good as area measurement?

BACKGROUND: Lumbar spinal stenosis (LSS) is commonly assessed on MRI by measuring dural sac cross-sectional area (DSCA). A new method, morphological grading A-D, has recently been introduced as an alternative method. OBJECTIVE: The aim of this study is to compare these two different methods for assessing LSS on MRI and study their reliability and intercorrelation. METHODS: On pretreatment MRI of 84 patients, two experienced radiologists independently classified level L2/L3, L3/L4 and L4/L5 as no, relative or significant stenosis using both methods. Agreement was analyzed by weighted Kappa. The correlation between the two methods was analysed using Spearman correlation, and visualized in a box plot. RESULTS: The interobserver agreement (95 % CI) was 0.69 (0.61-0.77) and 0.65 (0.56-0.74), respectively. The intraobserver agreements for DSCA were 0.77 (0.60-0.74) and 0.80 (0.66-0.93). On morphological grading A-D it was 0.78 (0.65-0.92) and 0.81 (0.68-0.94). The correlation coefficient between the two methods was 0.85 (p < 0.001). Grades C and D were under the limit value for significant stenosis using the DSCA. CONCLUSIONS: The study shows that the inter- and intraobserver agreements of DSCA and morphological grading A-D were acceptable and their intercorrelation is strong. Both methods may be used in the MRI evaluation of LSS.

Dynamic cervical myelopathy in young adults.

PURPOSE: Non-traumatic cervical chronic joint instability in young adults is a rare and underexplored entity. We assessed the diagnostic relevance of dynamic MRI, and the clinical and radiological outcome after anterior cervical interbody fusion (ACIF) in these cases. METHODS: Six young patients (mean age 34 years) with cervical myelopathy without compression on static imaging had a dynamic MRI. Joint instability was defined by a reduction of the canal diameter on dynamic sequences. Clinical and radiological outcomes were assessed after surgery by examination, cervical X-rays, static and dynamic MRI. RESULTS: All the patients had joint instability. Four patients underwent surgery. Clinical status improved 1 year after surgery. All patients had a satisfactory fusion at 6-month follow-up and no residual compression at 1 year. CONCLUSION: Dynamic MRI can help detect a joint instability in young patients with cervical myelopathy without compression. ACIF seems to be efficient in these cases.

New MRI grading system for the cervical canal stenosis.

OBJECTIVE: The purpose of this study was to propose a new MRI grading system for cervical canal stenosis and to evaluate the reproducibility of the system. MATERIALS AND METHODS: Cervical canal stenosis was classified according to the T2-weighted sagittal images into the following grades: grade 0, absence of canal stenosis; grade 1, subarachnoid space obliteration exceeding 50%; grade 2, spinal cord deformity; and grade 3, spinal cord signal change. The MRI scans of 82 patients (37 men and 45 women; mean age, 65.2 years; range, 60-86 years) were independently analyzed by six radiologists. Interobserver and intraobserver agreements were analyzed using intraclass correlation coefficient (ICC), along with the percentage agreement and kappa statistics. RESULTS: The ICC for interobserver agreement was 0.716-0.802, indicating good-to-excellent agreement. For the distinction among the four grades, the percentage of agreement was 63-64% (κ = 0.60-0.62). The percentage of agreement for the presence of cervical canal stenosis (grade 0 vs grades 1, 2, and 3) was 79-85% (κ = 0.51-0.59). The percentage of agreement for insignificant (grade 0-1) or significant (grade 2-3) stenosis was 81-85% (κ = 0.57-0.66). The percentage of agreement for the presence of spinal cord signal change (grade 0-2 vs grade 3) was 92-95% (κ = 0.70-0.73). The overall intraobserver agreement was excellent, as determined by an ICC of 0.768. CONCLUSION: The new grading system provides a reliable assessment of cervical canal stenosis.

Is there a difference between narrowing of the spinal canal and neurological deficits comparing Denis and Magerl classifications?

STUDY DESIGN: Retrospective chart review. OBJECTIVES: The objective of the current study was to evaluate the correlation between neurological deficits and the severity of narrowing of the spinal canal in patients with thoracic, thoracolumbar and lumbar burst-type fractures by comparing the classifications of Denis and Magerl. From 1989 to 2005, a total of 227 patients with burst fractures following Denis' criteria were studied. SETTING: Tertiary teaching institution. METHODS: Computed tomographic scans of the fractured spine were analyzed to assess the narrowing of the spinal canal. Following Magerl's criteria, patients were later subdivided into two groups according to the presence of associated ligament injuries, out of which 185 patients had no such injuries and the remaining 42 patients were classified as Megerl group B. RESULTS: Results were evaluated based on the initial neurological status of patients according to Frankel and based on the midsagittal diameter of the fractured vertebra. A significant correlation was found between the narrowing of the spinal canal and neurological deficits in both classifications, with no significant differences between either. CONCLUSION: The percentage of narrowing of the spinal canal proved to be a pre-disposing factor for the severity of the neurological status in thoracolumbar and lumbar burst-type fractures according to the classifications of Denis and Magerl. The greater the bone fragment in the spinal canal, the greater will be the probability of neurological deficits in both fracture classifications, equally.

Spinal Stenosis Grading in Magnetic Resonance Imaging Using Deep Convolutional Neural Networks.

STUDY DESIGN: Retrospective magnetic resonance imaging grading with comparison between experts and deep convolutional neural networks (CNNs). OBJECTIVE: This study aims to verify the feasibility of a computer-assisted spine stenosis grading system by comparing the diagnostic agreement between two experts and the agreement between the experts and trained artificial CNN classifiers. SUMMARY OF BACKGROUND DATA: Spinal stenosis grading is important; however, it is tedious job to check the MR images slide by slide to classify patient grades often having different opinions regarding the final diagnosis. METHODS: For 542 L4-5 axial MR images, two experts independently localized the center position of the spine canal and graded the status. Two CNN classifiers each trained with the grading label made by the two experts were validated using 10-fold cross-validation. Each classifier consisted of a CNN detection model responsible for the localization of patches near the canal and a classification CNN model to predict the spinal stenosis status in the localized patches. Faster R-CNN was used for the detection model whereas VGG network was used for the classification model. A comparison in grading agreement was carried out between the two experts as well as that of the experts and the prediction results generated by the CNN models. RESULTS: Grading agreement between the experts was 77.5% and 75% in terms of accuracy and F1 scores. The agreement between the first expert and the model trained with the labels of the first expert was 83% and 75.4%, respectively. The agreement between the second expert and the model trained with the labels of the second expert was 77.9% and 74.9%. The differences between the two experts were significant, whereas the differences between each expert and the trained models were not significant. CONCLUSION: We indeed confirmed that automatic diagnosis using deep learning may be feasible for spinal stenosis grading. LEVEL OF EVIDENCE: 4.

Assessment of lumbar spinal canal morphology with digital computed tomography.

BACKGROUND: The study of lumbar spine pathology requires adequate preparation and knowledge of the normal structure of this part of the spine. The main goal of the study was to assess spinal canal morphology with computed tomography. The sagittal and interpedicular dimensions and surface area were considered the most important measurements. An additional goal was to assess the shape of the spinal canal and intervertebral joint angles. MATERIAL AND METHODS: Computed tomography was used to assess the lumbar spinal canals of 42 people to an accuracy of 0.01 using a special console for digital analysis. RESULTS: The mean sagittal dimension showed minor differences and ranged from 15.75+/-0.886 at the L3 level to 17.77+/-1.619 at the L5 level. The mean interpedicular dimension was significantly different between the levels, increasing from 24.75+/-2.173 at L3 to 34.57+/-3.332 at L5. Similar results were obtained as regards the mean surface area of the spinal canal. The surface area was 277.2+/-36.15 mm2 at the L3 level, compared to 297+/-9.90 mm2 at L4 and 386.5+/-50.55 mm2 at L5. The spinal canal shape at the L4-L5 level was triangular or trefoil in all 42 patients. No significant differences were found between the angles of right and left intervertebral joints. CONCLUSIONS: Our results do not differ from those described in literature. A sagittal dimension over 15 mm, and an interpedicular dimension of more than 25 mm are characteristic of a normal spinal canal. The results constitute reference data for further studies concerning lumbar stenosis.

Digital computed tomography affords new measurement possibilities in lumbar stenosis.

INTRODUCTION: The problem of lumbar stenosis has been analysed at length in the literature as the number of patients with low back pain of this aetiology continues to increase. The aim of this study was:1. to carry out a prospective study assessing the dimensions of spinal canal on the basis of CT data and to compare patient data with a control group.2. to determine if the sagittal and transverse dimensions and surface area of the spinal canal are sufficiently sensitive and robust measures of spinal canal stenosis at L3, L4 and L5 levels. MATERIAL AND METHODS: The investigational group consisted of 176 patients (93 men, 83 women). A total of 528 vertebral levels were evaluated and compared with a control group consisting of 42 persons. Digital CT scans were obtained with a precision of 0.01 mm and 0.01 mm2. A discriminative function algorithm was used to classify cases according to the level of stenosis. RESULTS: The mean sagittal dimension at L3 was 13.26 mm and the mean transverse dimension was 23.36 mm, with a surface area of 244.39 mm2. At L4, the mean sagittal dimension was 14.12 mm, the mean transverse dimension was 24.60 mm, and the surface area was 267.70 mm2. At L5, the mean sagittal dimension was 14.76 mm, the mean transverse dimension was 31.38 mm, and the surface area was 303.99 mm2. The most important factors influencing the quality of classification were height, width and surface area. Student's t test with a significance level at p=0.05 revealed statistically significant differences. The accuracy of classification in discriminative analysis was 92.66%. CONCLUSIONS: The proposed indicators of the sagittal and transverse dimensions and surface area of the spinal canal were useful in assessing quantitative changes with this investigational technique. The sagittal dimension had the greatest sensitivity in the evaluation of stenosis.

Observer agreement of spine stenosis on magnetic resonance imaging analysis of patients with cervical spine myelopathy.

OBJECTIVES: The purpose of this study was to measure the intraobserver and interobserver reliability of magnetic resonance detection of cervical spondylotic myelopathy with and without operational guidelines. METHODS: Seven radiologists examined images from 10 patients with cord signal abnormalities and clinical signs of myelopathy. Radiologist examined films twice, with and without operational guidelines designed to define stenotic changes, while blinded to the clinical findings of the patients. Analyses included a Fleiss kappa assessment of intraobserver and interobserver reliability. RESULTS: Results demonstrated high percentage of agreement and strong intraobserver reliability and variable Fleiss kappa values for interobserver assessment. Operational guidelines did not improve the intraobserver or interobserver agreement. CONCLUSION: Although the percentage of agreement was high in some cases, the kappa agreement was low-most likely a result of the base rate problem of a kappa analysis. Sample bias toward severe degenerative changes resulted in highly prevalent selections and kappa adjusted values. Nonetheless, the results do suggest that substantial intraobserver kappa agreement and a wide range of interobserver kappa agreement exists among trained radiologists during detection of stenotic changes associated with cervical spondylotic myelopathy.

Scoping review to develop common data elements for lumbar spinal stenosis.

BACKGROUND CONTEXT: Common data elements (CDE) represent an important tool for understanding and classifying health outcomes across settings. Although CDEs have been developed for a number of disorders, to date CDEs for lumbar spinal stenosis (LSS) have not been fully developed. To facilitate the identification of CDEs and measures to assess them, this technical study leverages the International Classification of Functioning, Disability and Health (ICF), peer-reviewed research, and a panel of experts to identify CDEs specific to LSS. PURPOSE: The study aimed to define CDEs for disease characteristics and outcomes of LSS using the World Health Organization's ICF taxonomy, and to facilitate the selection of assessment instruments for research and clinical care. DESIGN: This is a scoping review using a modified Delphi approach with a technical expert panel composed of clinicians and scientists representing the academia, policy and advocacy stakeholders, and professional associations with expertise in LSS. METHODS: This is a scoping review to identify measures that assess LSS symptoms. Thirty-one subject matter experts (SMEs) prioritized ICF codes and evaluated instruments measuring specific domains. We used a modified Delphi technique to evaluate item-level content and achieve consensus. RESULTS: SMEs prioritized 53 ICF codes; 3 received 100% endorsement, 27 received ≥90% endorsement, whereas the remaining 23 received ≥80% endorsement. Prioritized ICF codes represent diverse domains, including pain, activities and participation, and emotional well-being. The review yielded 58 instruments; we retained 24 for content analysis. CONCLUSIONS: The retained instruments adequately represent the ICFs activities and participation, and body function domains. Body structure and environmental factors were assessed infrequently. Adoption of these CDEs may guide clinical decision making and facilitate comparative effectiveness trials for interventions focused on LSS.