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AI-powered spinal stenosis detection on MRI. Grade central canal, lateral recess, and foraminal narrowing with ligamentum flavum hypertrophy assessment. 4 AI models analyze multi-level compression in parallel.
Spinal stenosis is the narrowing of the spinal canal, lateral recesses, or neural foramina, resulting in compression of the spinal cord or nerve roots. It most commonly affects the lumbar spine (causing neurogenic claudication) and cervical spine (causing myelopathy). Causes include degenerative changes, disc herniations, ligamentum flavum hypertrophy, and facet joint arthropathy. Our AI consortium evaluates stenosis at each level, grades severity, and identifies the contributing anatomical factors.
The most widely used imaging classification grading lumbar central canal stenosis rates the degree of thecal sac compression on axial T2 MRI: grade A (no contact with nerve roots), grade B (nerve roots displaced but no clumping), grade C (nerve root clumping), and grade D (no CSF visible and nerve roots indistinguishable). The anteroposterior canal diameter less than 10 mm is considered absolute stenosis; 10–13 mm is relative stenosis. Foraminal stenosis is additionally assessed using Pfirmann criteria for disc height and foraminal fat obliteration. These measurements guide decisions between conservative management, epidural steroid injections, and surgical decompression.
Modic type I changes in adjacent endplates (low T1, high T2 signal indicating bone marrow edema and active inflammation) correlate with symptomatic axial pain superimposed on stenotic symptoms. Pfirrmann grade IV–V disc degeneration at the stenotic level confirms chronic degenerative etiology. High-intensity zones (HIZ) in the annulus represent annular fissuring. On axial T2 images, loss of the bright CSF rim around the dural sac and nerve root clumping indicate functionally significant compression. Myelopathy in cervical stenosis is suggested by T2 hyperintensity within the spinal cord (myelomalacia), a poor prognostic sign.
Surgery is appropriate when neurogenic claudication significantly limits daily activities after at least 6–12 weeks of conservative measures including physical therapy, NSAIDs, and epidural steroid injections. Cauda equina syndrome with bowel or bladder dysfunction or rapidly progressive motor weakness constitutes a surgical emergency regardless of duration. The SPORT trial demonstrated that surgical decompression (laminectomy, with or without fusion for instability) provides superior outcomes at 4 years compared with nonoperative care for patients with confirmed stenosis and moderate-to-severe symptoms. Adjacent-segment disease and sagittal imbalance are key considerations for instrumented fusion versus decompression alone.
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