The nerve root sedimentation sign in diagnosis of lumbar spinal stenosis

Piechota, Małgorzata; Król, Robert; Elias, Damian O.; Wawrzynek, Wojciech; Lekstan, Andrzej

doi:10.1177/0284185118795322

Cited by 10 publications

(5 citation statements)

References 30 publications

(60 reference statements)

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“…In addition, the CSA of dural sac, as spinal canal area parameter, was superior to vertebral canal diameter line parameters in diagnosing LSS [18], due to the characteristics of the spinal canal morphology, some degenerative changes occur in the non-midline part of the spinal canal often induced lateral recess stenosis and nally lead to reduction in spinal canal volume [18]. However, some researcher considered that the CSA could be insu cient as a diagnostic tool [19,20]. Lohman et al [21] con rmed that the degree of LSS and the CSA of the dural sac had no signi cant correlation with the severity of clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

Relative risk factors of nerve root sedimentation sign (Sedsign) in patients with severe central lumbar spinal stenosis (LSS)

Yan

et al. 2021

Preprint

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Here we evaluated the incidence of positive nerve root sedimentation sign (Sedsign) and its correlation with MRI parameters in patients with severe lumbar spinal stenosis (LSS) to explore its pathogenesis. Among 209 patients with severe LSS, there were 290 levels with intervertebral narrowing, among which 248 had a positive Sedsign (a prevalence of 85.52%). We then analyzed those levels with a positive Sedsign relative to those with a negative Sedsign (42 levels). There was no significant difference between the two groups for the minimum cross-sectional area (CSA) of the dural sac or the minimum posteroanterior diameter (PAD) of the spinal canal. In contrast, there was a significant difference between the groups for the grade of degenerative facet joint (DFJ) (p < 0.05), the maximum thickness of ligamentum flavum (TLF) (p < 0.01), and the maximum cross-sectional area difference (CSAD) of the dural sac (p < 0.01). In addition, receiver operating characteristic (ROC) curves were used to identify associated factors. The area under the ROC curve for PAD was 0.608 (95%CI: 0.55−0.665, p < 0.05), for DFJ was 0.634 (95%CI: 0.576−0.69, p < 0.05), for TLF was 0.74 (95%CI: 0.742−0.839, p < 0.01), and for CSAD was 0.911 (95%CI: 0.875−0.943, p < 0.01). In summary, a positive Sedsign has notable advantages in assisting with the diagnosis of severe LSS. Compression of the dural sac from the rear may be the main cause of a positive Sedsign, and the TLF and DFJ parameters were the main relative risk factors.

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Section: Discussionmentioning

confidence: 99%

Relative risk factors of nerve root sedimentation sign (Sedsign) in patients with severe central lumbar spinal stenosis (LSS)

Yan

et al. 2021

Preprint

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“…The nerve root sedimentation sign was first described in LSS patients in the supine position by Barz et al 1 The sedimentation sign could be used as a supplemental diagnostic method of LSS because it can differentiate patients with severe LSS from asymptomatic patients while having the strength of being easily observed on MRI images [1][2][3]5]. In asymptomatic patients, gravity was thought to be responsible for the sedimentation of nerve roots to the dorsal part of the dural sac.…”

Section: Discussionmentioning

confidence: 99%

“…1 Since the discovery of this sign, several studies have demonstrated the high sensitivity and specificity of the sedimentation sign for severe lumbar spinal stenosis (LSS). [2][3][4][5] This sign is most often present in stenotic patients who need surgery. 6 A positive sedimentation sign may change to a negative sign following adequate surgical decompression of stenotic lumbar levels.…”

Section: Introductionmentioning

confidence: 99%

The Correlation Between Negative Nerve Root Sedimentation Sign and Gravity: A Study of Upright Lumbar Multi-Positional Magnetic Resonance Images

Zhang

Mesregah

Patel

et al. 2021

Global Spine Journal

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Study Design: Retrospective upright MRI study. Objective: To validate the presence of positive and negative nerve root sedimentation signs on multi-positional MRI in the upright position and explore the relationship between negative nerve root sedimentation and gravity. Methods: T2-weighted axial multi-positional images in the upright position at the intervertebral disc levels from L1–L2 to L4–L5 in 141 patients with non-specific low back pain were retrospectively assessed. A positive sedimentation sign was defined as the absence of nerve root sedimentation or the absence of dorsal conglomeration of nerve roots within the dural sac. A negative sedimentation sign was defined as nerve root sedimentation dorsally or dorso-laterally like a horseshoe. Intra-and inter-observer reliability was evaluated. The relationship between sedimentation sign and dural sac cross-sectional area (CSA), anterior-posterior (AP) diameter was also explored. Results: The kappa value of intra-observer reliability was 0.962 and inter-observer reliability was 0.925. Both positive and negative sedimentation signs did appear at all 4 lumbar levels, including L1/2, L2/3, L3/4 and L4/5. A positive sedimentation sign was associated with significantly decreased dural sac CSA and AP diameter at L2/3, L3/4 or L4/5 level when compared to negative sedimentation sign. Conclusions: Both negative and positive sedimentation signs appeared at the L1/2, L2/3, L3/4, and L4/5 levels on the upright MRI, which suggested that the presence of nerve roots sedimenting dorsally in patients may not be associated with gravity. Moreover, the current study supports that sedimentation signs on multi-positional MRI images could have the same diagnostic functions as on MRI images.

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“…After this original work, a number of studies consistently suggested that SedSign was a powerful tool in the differential diagnosis for LSS [7][8][9]. Such a view, however, was questioned by some researchers that a positive SedSign was merely suggestive of severe LSS [10,11] and the capability of SedSign in differentiating LSS from nonspeci c back pain was limited [12,13,11]. Although the inconsistent ndings may be due to patient sampling [11] and varied de nitions of stenosis and severity [14,13], it is important to note that such controversies re ected, more or less, the poor understanding of the mechanism leading to positive SedSign.…”

Section: Introductionmentioning

confidence: 99%

Gravity Determines the Direction of Nerve Roots Sedimentation in the Lumbar Spinal Canal

Yang¹,

Feng²,

Hong

et al. 2020

Preprint

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Objectives: To investigate the role of gravity in the sedimentation of lumbar spine nerve roots using magnetic resonance (MR) imaging of various body position. Methods: A total of 56 patients suffered from back pain and underwent conventional supine lumbar spine MR imaging were selected from sanmen hospital database. All the patients were called back to our hospital to perform MR imaging in prone position or lateral position. Furthermore, the sedimentation sign (SedSign) was determined based on the suspension of the nerve roots in the dural sac on cross-sectional MR images, and 31 cases were rated as positive and another 25 cases were negative. Results: The mean age of negative SedSign group was significantly younger than that of positive SedSign group (51.7±8.7 vs 68.4±10.5, P<0.05). The constitutions of clinical diagnosis were significantly different between patients with a positive SedSign and those with a negative SedSign (P<0.001). Overall, nerve roots of the vast majority of patients (48/56, 85.7%) subsided to the ventral side of the dural sac on the prone MR images, although that of 8 (14.3%) patients remain stay in the dorsal side of dural sac. Nerve roots of only one patient with negative SedSign did not settle to the ventral dural sac, while this phenomenon occurred in 7 patients in positive SedSign group (4% vs 22.6%, P<0.001). In addition, the nerve roots of all the five patients subsided to the left side of dural sac on lateral position MR images. Conclusions: The nerve roots sedimentation followed the direction of gravity. Positive SedSign, floating of nerve roots in the canal, may be a MR sign of lumbar pathology involved the spinal canal.

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The nerve root sedimentation sign in diagnosis of lumbar spinal stenosis

Cited by 10 publications

References 30 publications

Relative risk factors of nerve root sedimentation sign (Sedsign) in patients with severe central lumbar spinal stenosis (LSS)

Relative risk factors of nerve root sedimentation sign (Sedsign) in patients with severe central lumbar spinal stenosis (LSS)

The Correlation Between Negative Nerve Root Sedimentation Sign and Gravity: A Study of Upright Lumbar Multi-Positional Magnetic Resonance Images

Gravity Determines the Direction of Nerve Roots Sedimentation in the Lumbar Spinal Canal

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