Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Supervisor

Michele, Battié C.

Abstract

Objective: To investigate the association and relative contribution of facet joint hypertrophy and disc degeneration, particularly posterior disc bulging, with dural sac cross-sectional area and the prevalence and severity of lumbar central canal stenosis in a general adult male population.

Methods: 197 adult males from the Twin Spine Study were included in the study. Using axial MRI scans of the lumbar spine, central canal stenosis, facet joint hypertrophy, and posterior disc bulging were assessed at the L2/3 through L5/S1 spinal levels. Previously established measurement techniques and grading criteria were used to assess the structures of interest.

Results: Facet joint hypertrophy and posterior disc bulging were inconsistently associated with central canal stenosis when analyzed by spinal level, except for a consistent association of posterior disc bulging with qualitatively assessed LSS across all levels. Posterior disc bulging was also associated with both canal capacity and qualitatively assessed central canal stenosis when considering the combined levels of L3/4 and L4/5.

Conclusion and significance: Posterior disc bulging appears to play a more significant role in central canal stenosis than facet joint hypertrophy. However, both structures explained little of the variance in canal capacity or the odds of having stenosis, suggesting that other factors may be of greater importance. Further research using larger samples that can support more refined measures of facet joint hypertrophy, disc degeneration, and stenosis is needed to clarify their associations and confirm and expand our study findings.

Summary for Lay Audience

Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal resulting in compression of the neurovascular tissues contained within. LSS is a common source of pain and disability among older adults and is the most common reason for spinal surgery in individuals older than 65 years of age. The clinical symptoms of LSS include low back pain with or without radiating pain to the lower limbs, lower limb numbness, and pain during walking or standing. Narrowing of the spinal canal can occur due to various degenerative changes in the surrounding soft tissues or bones. Yet there is inadequate information about their contribution to the development of LSS.

The objective of our research was to clarify the association and relative contribution of degenerative changes in tissues bordering the spinal canal, specifically facet joint hypertrophy and disc bulging, to lumbar spinal stenosis prevalence and severity. We assessed these changes on lumbar magnetic resonance images (MRI) using established measurement techniques and grading criteria in a sample of 197 adult males. From the results, posterior disc bulging appears to play a more significant role in stenosis than facet joint hypertrophy. However, degenerative findings in both structures explained little of the presence and severity of stenosis, suggesting other factors may be of greater importance. Enhanced knowledge of the contributors to lumbar vertebral canal stenosis will advance understanding of the development of LSS and may advance our ability to work towards novel prevention and treatment strategies.

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