Does magnetic resonance imaging morphology correlate with preoperative neurological status in operatively treated lumbar canal stenosis? A retrospective study

Why This Matters

Lumbar canal stenosis is frequently evaluated with MRI, but clinicians often encounter patients whose imaging findings do not match their neurological examination. This mismatch can create uncertainty when deciding whether symptoms warrant surgical referral or continued conservative care.

This study reinforces an important clinical principle: MRI should support—not replace—the neurological examination. Treatment decisions should be driven by the patient’s functional impairment and objective neurological deficits rather than the apparent severity of stenosis on imaging alone.

What the Research Found

This retrospective study reviewed 100 consecutive surgical patients with lumbar canal stenosis and compared four commonly used MRI grading systems with preoperative neurological findings.

Key findings:

• • Only the Schizas classification consistently correlated with both motor and sensory deficits
  • The Miskin and Mandell (M&M) classification correlated with motor deficits only
  • The Lee and Menon grading systems did not correlate with neurological deficits
  • Regardless of MRI grading, the authors concluded that clinical symptoms and neurological findings—not imaging alone—should guide surgical decision-making

Clinical interpretation:
Although some MRI grading systems showed limited correlation with neurological impairment, imaging alone did not reliably reflect clinical severity. Objective neurological examination remains the most important factor when evaluating patients with lumbar canal stenosis.