Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review

Background: Beside symptoms and clinical signs radiological findings are crucial in the diagnosis of lumbar spinal stenosis (LSS). We investigate which quantitative radiological signs are described in the literature and which radilogical criteria are used to establish inclusion criteria in clincical studies evaluating different treatments in patients with lumbar spinal stenosis. Methods: A literature search was performed in Medline, Embase and the Cochrane library to identify papers reporting on radiological criteria to describe LSS and systematic reviews investigating the effects of different treatment modalities. Results: 25 studies reporting on radiological signs of LSS and four systematic reviews related to the evaluation of different treatments were found. Ten different parameters were identified to quantify lumbar spinal stenosis. Most often reported measures for central stenosis were antero-posterior diameter (< 10 mm) and cross-sectional area (< 70 mm2) of spinal canal. For lateral stenosis height and depth of the lateral recess, and for foraminal stenosis the foraminal diameter were typically used. Only four of 63 primary studies included in the systematic reviews reported on quantitative measures for defining inclusion criteria of patients in prognostic studies. Conclusions: There is a need for consensus on well-defined, unambiguous radiological criteria to define lumbar spinal stenosis in order to improve diagnostic accuracy and to formulate reliable inclusion criteria for clinical studies

Does sport participation (including level of performance and previous injury) increase risk of osteoarthritis? A systematic review and meta-analysis

Background: To assess the relationship between sport and osteoarthritis, and specifically to determine whether previous participation, in terms of level (elite or non-elite), type of sport, intensity or previous injury were associated with osteoarthritis. Methods: This systematic review was developed using PRISMA guidelines. Databases were searched (to May 2016). Narrative review and meta-analysis (with risk ratio (RR) and 95% confidence intervals (CI)) approaches were undertaken where appropriate. Study quality was assessed using GRADE. Results: Forty-six studies were included. Narratively, 31 studies reported an increased risk of osteoarthritis, with 19 demonstrating an increased risk in elite athletes. There was an increased risk after sports exposure (irrespective of type) (RR:1.37; 95% CI:1.14, 1.64; 21 studies). It remained uncertain whether there was a difference in risk of osteoarthritis between elite and non-elite athletes (RR:1.37; 95% CI:0.84, 2.22; 17 studies). Risk was higher in soccer (RR:1.42; 95% CI:1.14, 1.77; 15 studies), but lower runners (RR:0.86; 95% CI:0.53, 1.41; 12 studies). Nine studies showed an association with the intensity of sport undertaken and osteoarthritis. Five studies demonstrated a higher prevalence of osteoarthritis following meniscectomies and anterior cruciate ligament tears. Overall the evidence was of GRADE 'very low' quality. Conclusions: There was very low quality evidence to support an increased relationship between sports participation and osteoarthritis in elite participants. It is unclear whether there is a difference in risk between elite and non-elite participants with further prospective studies needed to evaluate this. Pooled findings suggested significant injuries were associated with OA in soccer players

Spinal stenosis subsequent to juvenile lumbar osteochondrosis

This paper describes eight patients with spinal stenosis associated with marked osteochondrous changes in the vertebral bodies due to juvenile lumbar osteochondrosis (Scheuermann's disease). In no case was the midsagittal or interpedicular diameter of the spinal canal indicative of bony stenosis. On the other hand, in the myelograms the sagittal diameter of the dural sac was in all cases significantly narrowed, a diagnostic sign of central spinal stenosis. Therefore, myelography should always be contemplated when osteochondrous changes are present and spinal stenosis is suspected clinically regardless of whether the spinal canal diameters are normal in plain films.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46799/1/256_2004_Article_BF00204096.pd