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Spinal Stenosis Imaging Tests for Neuroclaudication  
  Literature Reviewed.  Lumbar spinal stenosis involves impingement of the cauda equina nerves in the spinal canal, lateral spinal canal, or neural foramina.  This is usually a degenerative condition resulting from ligamentous infolding and bony hypertrophy commonly seen in persons over age 60.  Spinal stenosis is occasionally developmental, due to congenitally short pedicles, and can affect younger individuals. 
  One meta-analysis on the accuracy of CT, MRI, and myelography for diagnosing lumbar spinal stenosis in adults was reviewed.297  Of the 116 articles the authors screened for this meta-analysis, 14 studies met their inclusion criteria for review.273, 275, 306, 309, 312, 313, 314, 315, 316, 317, 318, 319, 320, 321 
  Evidence on Efficacy.    In their meta-analysis, Kent, Haynor, Larson, et al.,297 concluded that estimates of accuracy of the imaging tests for diagnosing spinal stenosis were imprecise and that all 14 studies had methodological flaws (all judged to be of fair or poor quality).  However, based on data available, the meta-analysis found CT and MRI of similar accuracy for diagnosing spinal stenosis (true positive and true negative rates approximately 90 percent and 80 percent) and plain myelography with lower accuracy.  The authors cautioned that because of bias, estimates of test accuracy obtained by the meta-analysis were likely to be too high. 
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