Canal lombar estreito: sinal da sedimentação

Abstract

Objective: To verify the presence of the sedimentation sign in patients with lumbar spinal stenosis (LSS) in comparison to those without LSS. Methods: Retrospective, cross-sectional and descriptive study. Review of the imaging processes of patients with LSS operated between January 1, 2008 and December 31, 2009, comparing with patients without LSS observed in outpatient consultations. Patients were divided into two groups: group I had 34 patients with a diagnosis of LSS. Diagnostic criteria: existence of low back pain and/or neurogenic claudication and/or radiculopathy, associated with an anteroposterior canal diameter of less than 10 mm. Group II had 40 patients observed in outpatient consultations for low back pain without clinical LSS. The canal diameter was measured and the presence of the sedimentation sign between D12 and S1 was verified. Results: A positive sedimentation sign was identified in 31 of the 34 patients in group I (91.2%); only below the stenosis in two of these 31 patients. The sign was not observed in the patients in group II. A statistically significant correlation was observed between the variables "canal diameter" and "presence of sedimentation sign" (p < 0.01) in the group of patients with lumbar spinal stenosis. Conclusion: The diagnosis of LSS is not always easy due to the frequent dissonance between the clinical and imaging findings. The sedimentation sign is positive in patients with LSS between L1 and L5 and can be a valid sign to complement the diagnosis of LSS.Keywords: Lumbar; Roots; Diagnosis; Magnetic resonance spectroscopy; Sedimentation. RESUMO

Correlation Between Lumbar Spinal Stenosis Based on Morphology of the Dural Sac and the Quality of Life

“…With the increased life expectancy of the population due to lifestyle changes and the practice of healthy activities, degenerative conditions of several joints and of the lumbar spine play a much greater role in the day-to-day routine of spine surgeons. [1][2][3] Several tools for the better diagnosis, classification, and treatment of these illnesses are described in the literature. 6,7,[10][11][12] In patients with lumbar stenosis, magnetic resonance can show the degree of narrowing, the characteristics of structures, such as the disc and the ligamentum flavum, and the disposition of the nerve roots at high quality.…”

“…The criterion used for the subdivision was the nerve root sedimentation sign, which is present in A1 and A2 (being designated A-1) and absent in A3 and A4 (being designated A-2). 3 After the questionnaires were applied and the respective scores calculated, the data used were the percentage of dysfunction as determined by the ODI, the physical (PCS) and mental (MCS) function scores and symptom severity scales (painful and neuroischemic) found in the SF-36, the physical function scale as measured by the SSS, in addition to the scores from the EQ-5D questionnaire. Patient satisfaction, which is a part of the SS, was not used because none of the patients had yet been submitted to surgical treatment.…”

“…To date, the criteria for diagnosis and classification are still not widely accepted, leading studies to use different eligibility criteria, thus limiting the generalization of the reported results. [1][2][3] It is classified as primary or secondary, 2,4 congenital stenosis being rare, presenting short pedicles, and narrowing of the spinal canal. Secondary stenosis is associated with degenerative changes to the spinal joint complex.…”

“…[4][5][6] Additional signs are important and desired in guiding a surgical decision. 3,7 In this way, the measurement of the area of the cross--section of the dural sac and the anteroposterior diameter have come to be used as evidence of stenosis of the lumbar canal. 8 Also, in 2008, Landim developed a classification system based on morphopathological criteria related to the etiology and location of the compression of the neural elements, which helped in the identification of the pathology of stenosis, guiding the selection of the best surgical approach.…”

Sedimentation signal correlation and “Swiss spinal questionnaire” in lumbar stenosis

“…2 Barz et al 3 demonstrated that patients without vertebral stenosis submitted to magnetic resonance imaging (MRI) presented a migration of the roots to the dorsal region of the dural sac due to gravitational action, whereas in patients with vertebral stenosis they found images of the roots without this conformation, thus defining the first as a sign of sedimentation present and the second as a sign of absent sedimentation ( Figure 1). 4,5 Patients with lumbar stenosis present variable clinical manifestations such as neurogenic claudication that manifests as a sensation of weight in the lower back radiating to the buttocks and lower limbs, numbness, weakness or burning; and sciatica as the most common complaints. Usually the symptoms do not accompany dermatomes, they are related to the physical activity and the patient adopts posture in flexion of the spine when wandering to decrease the complaints.…”