Researchers Develop New Classification For Diagnosing Cervical Spinal Stenosis

Physician-researchers at the Rothman Institute of Thomas Jefferson University in Philadelphia, Pa., have developed a new, clinically meaningful scale of severity for diagnosing patients with cervical spinal stenosis. Their goal was to create a more accurate scale than the current “mild, moderate or severe” designations used for patients with this condition, a narrowing of the spinal canal in the neck. Researchers sought to create a reproducible, clinically validated classification of central cervical stenosis.

The group presented their results at the American Association of Orthopedic Surgeons (AAOS) annual meeting in Chicago, Ill., on March 20.

The current scale, researchers contended, does not carry any clinical or anatomical correlation. The presence or absence of cerebrospinal fluid (CSF) around the spinal cord is used as an important clinical decision-making factor.

“We wanted to make a scale that defined more accurately the clinical decision making of the cervical spine,” says Kristen E. Radcliff, M.D., assistant professor at Jefferson Medical College and lead researcher.

Five fellowship-trained surgeons, three spine surgery fellows and three orthopedic residents reviewed 46 cases and scored each according to the following scale: Grade 0 – no loss of CSF; grade 1 – some loss of CSF; grade 2 – complete loss of CSF space; grade 3 – loss of CSF space and deformation of the spinal cord greater than 25 percent; grade 4 – loss of CSF space and signal change in spinal cord (the most severe case).

“CSF space is an important marker for appropriate spinal cord perfusion and presence or absence of compression,” said Radcliff.

Each surgeon rated the level of spondylolisthesis, or bone slippage; kyphosis, the over curvature or hunching of the upper back; and any symptoms of spinal cord damage.

Researchers found a statistically significant number of patients on whom spinal decompression was recommended in higher grades, with 83 percent in grade 2, 95 percent in grade 3, and 100 percent (44 out of 44) in grade 4.

The result is a new anatomically-based, clinically validated classification of cervical stenosis that aids the surgical decision-making process and allows for swift diagnosis and the most urgent surgical intervention for those with symptomatic grade 2-4 stenosis. Patients with lower grade stenosis first are recommended and often better suited for nonsurgical treatment.

“It is our hope that this study allows for a more complete diagnosis, improves the accuracy of research and aids in improving communication regarding the severity of patients’ conditions,” added Radcliff.