Clinical Value of Nerve Root Sedimentation Sign in Lumbar Spinal Stenosis

Hyeon Jun Kim; Kyu Yeol Lee; Woo Chul Kim; Yong Seung Oh

doi:10.4184/jkss.2011.18.3.117

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Kim, Lee, Kim, and Oh: Clinical Value of Nerve Root Sedimentation Sign in Lumbar Spinal Stenosis

Original Article

Journal of Korean Spine Surg 2011;18(3):117-122.

Published online: 21 September 2011

DOI: https://doi.org/10.4184/jkss.2011.18.3.117

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., Yong Seung Oh, M.D.

Department of Orthopedic Surgery, College of Medicine, Dong-A University

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 E-mail: gylee@dau.ac.kr

Received 20 June 2011 Revised 2 September 2011 Accepted 2 September 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

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Figures and Tables%

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.

Table 1.

Results of sedimentation sign in LSS and LBP

	*LSS	†LBP	Total
Positive sedimentation sign	265	0	265
Negative sedimentation sign	37	142	179
Total	302	142	444

Odds ratio=8.162, p-value < 0.001, ‡CI: 6.036-11.038*LSS: lumbar spinal stenosis, †LBP, low back pain; ‡CI, confidence indicator.

Table 2.

Number of involved segment on Group I and Group II

Number of involved segment	Group I (n=265)	Group II (n=37)	p-value
1 segment involved	86	33	p<0.001
2 more segments involved	179	4	p<0.001

Odds ratio=0.13, 95% CI: 0.05-0.32

Table 3.

Results of MVAS, KODI on Group I and Group II

		Group I	Group II
	Preoperative	62.6±5.8	52.4±3.1
*MVAS	Postoperative	22.3±3.4	36.5±1.5
	Improvement (%)	64.5±4.6%	34.6±2.3%
	Preoperative	27.7±5.2	27.1±2.1
†KODI	Postoperative	10.1±2.6	17.2±1.5
	Improvement (%)	62.9±3.9%	62.9±3.9%

*MVAS: Millinion Visual Analogue Scale, † KODI: Korean Oswestry Disability Index

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