Acta Neurochirurgica

, Volume 160, Issue 3, pp 419–424 | Cite as

Decompressive surgery for lumbar spinal stenosis across the Atlantic: a comparison of preoperative MRI between matched cohorts from the US and Norway

  • Amandeep Bhalla
  • Thomas D. Cha
  • Clemens Weber
  • Ulf Nerland
  • Sasha Gulati
  • Greger Lønne
Original Article - Spine



There are no uniform guidelines regarding when to operate for Lumbar Spinal Stenosis (LSS). As we apply findings from clinical research from one population to the next, elucidating similarities or differences provides important context for the validity of extrapolating clinical outcomes. The aim of this study was to compare the morphological severity of lumbar spinal stenosis on preoperative MRI in patients undergoing decompressive surgery in Boston, USA, and Trondheim, Norway.


In this observational retrospective study, we compared morphological severity on MRI before surgical treatment between two propensity score-matched patient populations with single or two-level symptomatic LSS. We assessed the radiographic severity of LSS utilizing the Schizas classification (grade A to D).


Following propensity score matching, demographics are balanced. In the Trondheim cohort, two levels decompression were present in 36.2% of the patients vs. 41.9% in Boston, (p = 0.396). There was no significant difference in grades A to D concerning central stenosis (p = 0.075). When dichotomized in mild/moderate (A/B) and severe /extreme (C/D), there were no significant differences in the rate of levels operated for high-grade stenosis (C/D), 67.6% in the Boston group compare to 78.1% in the Trondheim group (p = 0.088).


Trondheim, Norway, and Boston, US, have similar radiographic thresholds of LSS for offering surgery.


Lumbar spinal stenosis Magnetic resonance imaging Schizas classification Decompression Propensity score matching 



Author GL has received research grants from the Fulbright Scholars Foundation to GL (ID: 68150249). Author TC received research grants support from North American Spine Society, Gordon and Betty Moore Foundation, Institutional Fellowship Support from OMEGA, Nuvasive, K2M, and id consulting - Bio2, GE Healthcare, Nuvasive and K2 M. The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of, and approved by, ethical review boards in Norway (REC South-east: 2015/1909 C) and at Partners Healthcare in Boston (IRB: 2015P002004) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of retrospective study, formal consent is not required in the USA, informed consent was obtained from all individual participants included in the study from Norway.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Orthopaedic Surgery, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  3. 3.Department of NeurosurgeryStavanger University HospitalStavangerNorway
  4. 4.Department of NeurosurgerySt. Olavs University HospitalTrondheimNorway
  5. 5.Department of NeuroscienceNorwegian University of Science and TechnologyTrondheimNorway
  6. 6.Department of OrthopaedicsInnlandet Hospital TrustLillehammerNorway

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