Application value of nerve root sedimentation sign in lumbar spinal stenosis revealed on MRI

doi:10.3969/j.issn.2095-4344.2017.31.021

Abstract

Abstract:

BACKGROUND: Clinical value of the nerve root sedimentation sign in patients with lumbar spinal stenosis (LSS) is still uncertain.

OBJECTIVE: To investigate the positive rate and correlation of the nerve root sedimentation sign in patients with LSS.

METHODS: Totally 281 patients complaining lumbago or low back pain underwent MRI examination in the Orthopedic Clinic or Ward of Jinshan Hospital of Fudan University, including 119 males and 162 females. The cross-sectional area and sagittal diameter of the spinal canal were measured, and the patients were then divided into two groups according to the presence and absence of LSS. Finally, the positive rate of nerve root sedimentation sign was compared.

RESULTS AND CONCLUSION: (1) Grouping based on the presence and absence dural sac cross-sectional area stenosis: the positive rate of nerve root sedimentation sign in sever, non, and mild LSS patients was 91.4%, 39.6%, and 53.5%, respectively, and the difference was significant (P < 0.05), but the positive rate showed no significant difference between mild and moderate as well as moderate and severe LSS patients. (2) Grouping according to the presence and absence spinal canal sagittal diameter stenosis: there was a significant difference in the positive rate of nerve root sedimentation sign between non-LSS and LSS patients (44.3% vs. 76.1%, χ²=21.469, P=0.000). (3) Grouping based on the dural sac cross-sectional area combined with spinal canal sagittal diameter: the dural sac cross-sectional area < 120 mm² or the spinal canal sagittal diameter < 10 mm indicating LSS, there was a significant difference in the positive rate of nerve root sedimentation sign between non-LSS and LSS patients (40.6% vs. 80.6%,χ²=30.539, P=0.000). (4) These results indicate that the diagnosis value of nerve root sedimentation sign in LSS is still under discussion. Although a positive sedimentation sign exclusively and reliably occurs in patients with severe LSS, it is also higher in patients without LSS. It may be inappropriate to take nerve root sedimentation sign as a diagnostic tool, but when combined with dural sac cross-sectional area and sagittal canal subsidence, it will be of great significance for the diagnosis of LSS.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Lumbar Vertebrae, Spinal Stenosis, Tissue Engineering

CLC Number:

R318

Chen Yan-chao, Yu Zuo-chong, Cao Rong, Yin Wang-ping. Application value of nerve root sedimentation sign in lumbar spinal stenosis revealed on MRI[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(31): 5042-5047.

Figures/Tables 2

2.2 患者术后情况患者术后一般情况良好，术后患者症状均有明显好转，未出现会阴部感觉麻木、尿便功能障碍等，1例出现患者术后出现发热，继续抗感染治疗后好转，未出现硬脊膜漏的情况。 2.3 男性和女性患者之间的比较男性119例，女性162例，其中男性腰椎管狭窄患者41例，女性腰椎管狭窄患者71例，神经根沉降征阳性率分别为70.7%和71.8%，男女之间腰椎管狭窄的患病率和神经根沉降征阳性率差异无显著性意义(χ2=0.015，P=1.000)，见表1。 2.4 单独以CSA是否狭窄进行分组比较按照CSA将存在腰椎管狭窄的患者分为轻中重3组，将狭窄和非狭窄患者进行比较，非狭窄患者169例，狭窄患者112例，神经根沉降征阳性率分别为39.6%和71.4%，非狭窄和狭窄患者的阳性率差异有显著性意义(χ2=27.277，P=0.000)。在狭窄患者中各组间比较，其中轻度与重度狭窄组间比较阳性率差异有显著性意义(χ2=13.358，P=0.000)，但中度和重度、轻度和重度患者之间阳性率差异无显著性意义。非狭窄组和轻中重度狭窄组患者中，阳性率分别为39.6%，53.5%，73.5%和91.4%，阳性率呈逐渐上升趋势，见表1。 2.5 单独以腰椎管矢状径是否狭窄进行分组比较按照椎管矢状径将患者是否存在腰椎管狭窄分为2组，其中非狭窄患者210例，狭窄患者71例，神经根沉降征阳性率分别为44.3%和76.1%，非狭窄和狭窄患者的阳性率差异有显著性意义(χ2=21.469，P=0.000)，见表1。 2.6 联合CSA和腰椎管矢状径两个指标分组进行比较 CSA< 120 mm2或者腰椎管矢状径< 10 mm提示存在腰椎管狭窄，所以将CSA和椎管矢状径两项指标结合一起，两项指标均非狭窄和同时存在狭窄的患者进行比较，其中非狭窄患者165例，狭窄患者67例，神经根沉降征阳性率分别为40.6%和80.6%，非狭窄和狭窄患者的阳性率差异有显著性意义(χ2=30.539，P=0.000)，见表1。 "

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