Anatomic, Image-based Classification of Diseased Lumbar Spinal Motion-Segment-Preliminary Clinical Report
Said G Osman*, Sukumar Sura, Mahesha anthila, Nebiyu S Osman and Naresh K Pagidimarry
Abstract
Purpose of the Study: To develop a comprehensive, treatment-orientated classification of lumbar spinal motion-segment disease.Materials and Methods: Contributors to spinal motion-segment disease - intervertebral disc, facet joint, ligamentum flavum and mal-alignment were identified. The degrees of abnormalities in each of these entities were coded, and the codes were entered in a table from which the possible combinations of pathologic processes were generated. Study of 57 lumbar MRI images (217 spinal motion-segments) was carried out to determine the prevalence of various combinations of the motion-segment disease. Pre- and post-operative MRI-based spinal motion-segment classifications were performed to evaluate the clinical application of this classification system in 15 patients.Results: This classification presents 494 possible combinations of the spinal motion-segment disease. Many of the combinations are only theoretical possibilities without clinical significance. Normal motion-segments, D0A0L0F0, represented 33.3% of the total motion-segments; D 1A0L0F0 was 8.8%, representing bulging disc, normal alignment, ligamentum flavum and facet joint. D2A0L0F2 was 6.9% representing intraannular disc herniation, normal alignment, mildly thickened ligamentum flavum, and hypertrophied superior articular process of the facet joint. 6.4% was D1A0L1F3 representing bulging disc, mildly hypertrophic ligamentum and hypertrophied facet joint. Clinical application of the classification revealed: Accurate anatomic classification; immediate post-operative classification changes which correlate with patient’s symptoms; pre-operative, immediate post-operative and late post-operative classifications which correlate with patient’s symptoms and accurately demonstrate post-operative remodeling of the motion-segment, especially after disc surgery, and accurate; and anatomic documentation of pre- and post op classifications of interlaminar endoscopic decompression.Conclusion: A treatment-orientated, standardized classification of spinal motion-segment disease is necessary considering current multiple treatment options and availability of sophisticated pre-operative imaging techniques. Such a classification will allow standardization of treatment options for various combinations of the pathological processes. With the emergence of new technologies surgical options can be upgraded based on a standardized classification. This in turn will help minimize confusion for those who want to learn and facilitate growth in the minimally invasive technology. The preliminary results of clinical application of the classification showed it to be a very accurate patho-anatomic representation; immediate post-operative classification change reflected clinical improvement post-operatively; and precise representation of post-operative remodeling of the motion-segment one to two years post-operatively. The precision of this classification allows accurate communication regarding the pathology, between providers across the globe, and more accurate comparison of results of different surgical interventions.