Background: Correlating symptoms and physical examination findings with surgical levels based on common\nimaging results is not reliable. In patients who have no concordance between radiological and clinical symptoms,\nthe surgical levels determined by conventional magnetic resonance imaging (MRI) and neurogenic examination\n(NE) may lead to a more extensive surgery and significant complications. We aimed to confirm that whether the\nuse of diffusion tensor imaging (DTI) and paraspinal mapping (PM) techniques can further prevent the occurrence\nof false positives with conventional MRI, distinguish which are clinically relevant from levels of cauda equina\nand/or nerve root lesions based on MRI, and determine and reduce the decompression levels of lumbar\nspinal stenosis than MRI + NE, while ensuring or improving surgical outcomes.\nMethods: We compared the data between patients who underwent MRI + (PM or DTI) and patients who\nunderwent conventional MRI + NE to determine levels of decompression for the treatment of lumbar spinal\nstenosis. Outcome measures were assessed at 2 weeks, 3 months, 6 months, and 12 months postoperatively.\nResults: One hundred fourteen patients (59 in the control group, 54 in the experimental group) underwent\ndecompression. The levels of decompression determined by MRI + (PM or DTI) in the experimental group\nwere significantly less than that determined by MRI + NE in the control group (p = 0.000). The surgical time,\nblood loss, and surgical transfusion were significantly less in the experimental group (p = 0.001, p = 0.011, p = 0.001,\nrespectively). There were no differences in improvement of the visual analog scale back and leg pain (VAS-BP, VAS-LP)\nscores and Oswestry Disability Index (ODI) scores at 2 weeks, 3 months, 6 months, and 12 months after operation\nbetween the experimental and control groups.\nConclusions: MRI + (PM or DTI) showed clear benefits in determining decompression levels of lumbar spinal stenosis\nthan MRI + NE. In patients with lumbar spinal stenosis, the use of PM and DTI techniques reduces decompression\nlevels and increases safety and benefits of surgery.
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