Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2011 Sep;18(3):117-122. Korean.
    Published online Sep 30, 2011.
    https://doi.org/10.4184/jkss.2011.18.3.117
    © Copyright 2011 Korean Society of Spine Surgery
    Original Article

    Clinical Value of Nerve Root Sedimentation Sign in Lumbar Spinal Stenosis

    Hyeon Jun Kim, M.D., Kyu Yeol Lee, M.D., Woo Chul Kim, M.D. and Yong Seung Oh, M.D.
      • Department of Orthopedic Surgery, College of Medicine, Dong-A University, Korea.
    • Corresponding author: Kyu Yeol Lee, M.D. Department of Orthopedic Surgery, College of Medicine, Dong-A University, 1, Dongdaesin-dong 3-ga, Seo-gu, Busan 602-715, Korea. TEL: 82.51-240-2867, FAX: 82.51-243-9764, Email: gylee@dau.ac.kr
    Received June 20, 2011; Revised September 02, 2011; Accepted September 02, 2011.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Study Design

    A retrospective study.

    Objectives

    To assess the diagnostic value of the sedimentation sign seen on MRI with lumbar spinal stenosis and to compare postoperative clinical results.

    Summary of Literature Review

    Nerve root sedimentation sign is an additional tool to diagnose lumbar spinal stenosis.

    Materials and Methods

    There were 302 patients enrolled that had been diagnosed with lumbar spinal stenosis by MRI, which were reviewed to identify a sedimentation sign and all underwent the operative treatment. There were 142 patients who could not have their spinal stenosis diagnosis confirmed by MRI, and thus were selected as the control group to estimate the diagnostic value of nerve root sedimentation sign.

    Correlation with the duration of preoperative symptoms and the number of involved segments were compared and analyzed between sedimentation sign positive (Group I) and negative (Group II). We estimated Million Visual Analogue Score (MVAS) and Korean Oswestry Disability Index (KODI) for the assessment of the pain and the functional disability.

    Results

    A positive sedimentation sign was found in 265 patients (87.7%) and diagnostic value was statistically significant (P<0.001). The involvement of 2 or more segments was significantly correlated with the sedimentation sign in the positive group (P<0.001). MVAS presented the improvement of 64.5±4.6%, KODI, 62.9±3.9% after surgical treatment in Group I. In Group II, each score showed improvement of 34.6±2.3% (MVAS), 37.1±1.8% (KODI). The improvement of these scores in Group I was better than in Group II.

    Conclusions

    The nerve root sedimentation sign is an additional tool to diagnose lumbar spinal stenosis and the considerable factor to decide the operation.

    Keywords
    Lumbar spine; Spinal stenosis; Sedimentation sign; Value of sedimentation sign

    Figures

    Fig. 1
    Comparison of MRI scans. (A) A positive sedimentation sign (B) A negative sedimentation sign

    Fig. 2
    MRI scans and radiographs shows lumbar spinal stenosis and a positive sedimentation sign. (A) Saggital view of MRI shows spinal stenosis at L3-4, L4-5. (B) Axial view shows a positive sedimentation sign. (C) Preoperative radiogragh shows degenerative and sclerotic changes. (D) Postoperative radiogragh shows the instrumented posterolateral fusion state.

    Tables

    Table 1
    Results of sedimentation sign in LSS and LBP

    Table 2
    Number of involved segment on Group I and Group II

    Table 3
    Results of MVAS, KODI on Group I and Group II

    References

      1. Hanley EN, Phillips ED, Kostuik JP. Who should be fused?. In: Frymoyer JW, editor. The Adult Spine. New York: Raven Press; 1991. pp. 1893-1917.
      1. Katz JN, Dalgas M, Stucki G, et al. Degenerative lumbar spinal stenosis. Diagnostic value of the history and physical examination. Arthritis Rheum 1995;38:1236–1241.
      1. Boswell MV, Trescot AM, Datta S, et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician 2007;10:7–111.
      1. Kang YH. Anatomic Consideration of Lumbar Spinal Stenosis. J Korean Soc Spine Surg 2000;7:94–99.
      1. Amundsen T, Weber H, Lilleås F, Nordal HJ, Abdelnoor M, Magnaes B. Lumbar spinal stenosis. Clinical and radiologic features. Spine (Phila Pa 1976) 1995;20:1178–1186.
      1. Kraft GH. Dermatomal somatosensory-evoked potentials in the evaluation of lumbosacral spinal stenosis. Phys Med Rehabil Clin N Am 2003;14:71–75.
      1. Wang YC, Jeng CM, Wu CY, et al. Dynamic effects of axial loading on the lumbar spine during magnetic resonance imaging in patients with suspected spinal stenosis. J Formos Med Assoc 2008;107:334–339.
      1. Cook C, Brown C, Michael K, et al. The clinical value of a cluster of patient history and observational findings as a diagnostic support tool for lumbar spine stenosis. Physiother Res Int. 2010
      1. Cho KJ, Moon KH, Kim MK, et al. Changes of Clinical Outcomes after Decompression and Fusion for Spinal Stenosis during 2-Year Follow-up Periods. J Korean Soc Spine Surg 2003;10:113–118.
      1. Ono A, Suetsuna F, Irie T, et al. Clinical significance of the redundant nerve roots of the cauda equina documented on magnetic resonance imaging. J Neurosurg Spine 2007;7:27–32.
      1. Jackson A, Isherwood I. Does degenerative disease of the lumbar spine cause arachnoiditis? A magnetic resonance study and review of the literature. Br J Radiol 1994;67:840–847.
      1. Laitt R, Jackson A, Isherwood I. Patterns of chronic adhesive arachnoiditis following Myodil myelography: the significance of spinal canal stenosis and previous surgery. Br J Radiol 1996;69:693–698.
      1. Barz T, Melloh M, Staub LP, et al. Nerve root sedimentation sign: evaluation of a new radiological sign in lumbar spinal stenosis. Spine (Phila Pa 1976) 2010;35:892–897.
      1. Chiodo A, Haig AJ, Yamakawa KS, Quint D, Tong H, Choksi VR. Magnetic resonance imaging vs. electrodiagnostic root compromise in lumbar spinal stenosis: a masked controlled study. Am J Phys Med Rehabil 2008;87:789–797.
      1. Herno A, Saari T, Suomalainen O, Airaksinen O. The degree of decompressive relief and its relation to clinical outcome in patients undergoing surgery for lumbar spinal stenosis. Spine (Phila Pa 1976) 1999;24:1010–1014.
      1. Chung SS, Lee CS, Lee SG, Choi HJ, Park BJ. Correlation between Clinical Features and MRI Findings in One Level Lumbar Spinal Stenosis. J Korean Orthop Assoc 1999;34:541–546.
      1. Olmarker K, Rydevik B. Single- versus double-level nerve root compression An experimental study on the porcine cauda equina with analyses of nerve impulse conduction properties. Clin Orthop Relat Res 1992;279:35–39.
      1. Javid MJ, Hadar EJ. Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study. J Neurosurg 1998;89:1–7.
      1. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976) 2000;25:2940–2952.
      1. Sirvanci M, Bhatia M, Ganiyusufoglu KA, et al. Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging. Eur Spine J 2008;17:679–685.
    Cited by
    Crossref 8
    Google Scholar 
    MeSH Terms
    Humans
    Retrospective Studies
    Spinal Stenosis
    Metrics
    Share
    Figures
    slide
    slide

    1 / 2

    Tables
    slide
    slide
    slide

    1 / 3

    PERMALINK