Skip to main content

Advertisement

SpringerLink
Log in

The nerve root sedimentation sign for differential diagnosis of lumbar spinal stenosis: a retrospective, consecutive cohort study

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Using MR imaging, nerve root sedimentation sign (SedSign) was demonstrated to have a high sensitivity and specificity for diagnosis of symptomatic lumbar spinal stenosis (LSS) in selected patients. This study was to evaluate the diagnostic value of SedSign in differential diagnosis of LSS and non-specific low back pain (LBP) in consecutive patients.

Methods

A series of consecutive patients with lumbar spinal MRI examination for back/leg pain in orthopeadic clinic were included. These patients were followed up and divided into two groups, symptomatic LSS and non-specific LBP, according to symptoms and radiological findings. Using MR images, SedSign was assessed by two spine surgeons and one radiologist independently. Then sensitivity and specificity of SedSign was calculated.

Result

A total of 320 patients (105 LSS and 215 non-specific LBP) were included. The SedSign had a sensitivity of 77.1 % and specificity of 47.0 % in the whole cohort. When these patients were stratified by dural sac cross-sectional areas (CSA), the SedSign had a sensitivity of 95.0 % and specificity of 4.7 % in patients with CSA ≤ 80 mm2 (severe radiologic stenosis), sensitivity of 74.2 % and specificity of 22.6 % in patients with CSA 80–100 mm2 (moderate radiologic stenosis), and sensitivity of 58.8 % and specificity of 61.0 % in patients with CSA 100–120 mm2 (mild radiologic stenosis). In selected cases composed by LSS patients with CSA ≤ 80 mm2 and non-specific LBP patients with CSA > 120 mm2, however, the SedSign had a sensitivity of 95.0 % and specificity of 80.0 %.

Conclusion

The present data demonstrated that the SedSign was not able to discriminate symptomatic LSS from non-specific LBP after adjusting by dural sac CSA. The diagnostic value of the SedSign was still uncertain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Amundsen T, Weber H, Lilleas F, Nordal HJ, Abdelnoor M, Magnaes B (1995) Lumbar spinal stenosis. Clinical and radiologic features. Spine (Phila Pa 1976) 20:1178–1186

  2. Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, Hwang SW, Mendel RC, Reitman CA (2013) An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J 13:734–743. doi:10.1016/j.spinee.2012.11.059

    Article  PubMed  Google Scholar 

  3. Watters WR, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, Bono CM, Ghiselli G, Heggeness MH, Mazanec DJ, O’Neill C, Reitman CA, Shaffer WO, Summers JT, Toton JF (2008) Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J 8:305–310. doi:10.1016/j.spinee.2007.10.033

    Article  PubMed  Google Scholar 

  4. de Schepper EI, Overdevest GM, Suri P, Peul WC, Oei EH, Koes BW, Bierma-Zeinstra SM, Luijsterburg PA (2013) Diagnosis of lumbar spinal stenosis: an updated systematic review of the accuracy of diagnostic tests. Spine (Phila Pa 1976) 38:E469–E481. doi:10.1097/BRS.0b013e31828935ac

  5. Andreisek G, Imhof M, Wertli M, Winklhofer S, Pfirrmann CWA, Hodler J, Steurer J (2013) A systematic review of semiquantitative and qualitative radiologic criteria for the diagnosis of lumbar spinal stenosis. Am J Roentgenol 201:W735–W746. doi:10.2214/AJR.12.10163

    Article  Google Scholar 

  6. Steurer J, Roner S, Gnannt R, Hodler J (2011) Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review. BMC Musculoskelet Disord 12:175. doi:10.1186/1471-2474-12-17

    Article  PubMed  PubMed Central  Google Scholar 

  7. Andreisek G, Hodler J, Steurer J (2011) Uncertainties in the diagnosis of lumbar spinal stenosis. Radiology 261:681–684. doi:10.1148/radiol.11111086

    Article  PubMed  Google Scholar 

  8. Sirvanci M, Bhatia M, Ganiyusufoglu KA, Duran C, Tezer M, Ozturk C, Aydogan M, Hamzaoglu A (2008) Degenerative lumbar spinal stenosis: correlation with Oswestry disability index and MR imaging. Eur Spine J 17:679–685. doi:10.1007/s00586-008-0646-5

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lohman CM, Tallroth K, Kettunen JA, Lindgren KA (2006) Comparison of radiologic signs and clinical symptoms of spinal stenosis. Spine (Phila Pa 1976) 31:1834–1840. doi:10.1097/01.brs.0000227370.65573.ac

  10. Barz T, Melloh M, Staub LP, Lord SJ, Lange J, Roder CP, Theis JC, Merk HR (2010) Nerve root sedimentation sign: evaluation of a new radiological sign in lumbar spinal stenosis. Spine (Phila Pa 1976) 35:892–897. doi:10.1097/BRS.0b013e3181c7cf4b

  11. Wang D, Yang Q, Gao S, Ding L, Zhang Y (2013) The study of relationship between the nerve root sedimentation syndrome and lumbar spinal stenosis. Acta Univ Med Anhui 48:520–523

    Google Scholar 

  12. Resende VAC, Teixeira A, Silva JBD, Costa Neto A, Leal FJF, Gouveia ARF, Miranda A (2013) Lumbar spinal stenosis: sedimentation sign. Coluna/Columna 12:192–195

    Article  Google Scholar 

  13. Kim HJ, Lee KY, Kim WC, Oh YS (2011) Clinical value of nerve root sedimentation sign in lumbar spinal stenosis. J Korean Soc Spine Surg 18:117–122

    Article  Google Scholar 

  14. Tomkins-Lane CC, Quint DJ, Gabriel S, Melloh M, Haig AJ (2013) Nerve root sedimentation sign for the diagnosis of lumbar spinal stenosis: reliability, sensitivity, and specificity. Spine (Phila Pa 1976) 38:E1554–E1560. doi:10.1097/BRS.0b013e3182a8c2da

  15. Macedo LG, Wang Y, Battie MC (2013) The sedimentation sign for differential diagnosis of lumbar spinal stenosis. Spine (Phila Pa 1976) 38:827–831. doi:10.1097/BRS.0b013e31827e8ecd

  16. Laudato P, Schizas C (2013) Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis. Neuroradiology 55:786

    Google Scholar 

  17. Zhang L, Chen R, Xie P, Zhang W, Yang Y, Rong L (2015) Diagnostic value of the nerve root sedimentation sign, a radiological sign using magnetic resonance imaging, for detecting lumbar spinal stenosis: a meta-analysis. Skeletal Radiol 44:519–527. doi:10.1007/s00256-014-2064-6

    Article  PubMed  Google Scholar 

  18. Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C (2010) An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 19:2075–2094. doi:10.1007/s00586-010-1502-y

    Article  PubMed  PubMed Central  Google Scholar 

  19. Peul WC, Bredenoord AL, Jacobs WC (2014) Avoid surgery as first line treatment for non-specific low back pain. BMJ 349:g4214

    Article  PubMed  Google Scholar 

  20. Mariconda M, Fava R, Gatto A, Longo C, Milano C (2002) Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis: a prospective comparative study with conservatively treated patients. J Spinal Disord Tech 15:39–46

    Article  PubMed  Google Scholar 

  21. Schonstrom N, Willen J (2001) Imaging lumbar spinal stenosis. Radiol Clin North Am 39:31–53

    Article  CAS  PubMed  Google Scholar 

  22. Hamanishi C, Matukura N, Fujita M, Tomihara M, Tanaka S (1994) Cross-sectional area of the stenotic lumbar dural tube measured from the transverse views of magnetic resonance imaging. J Spinal Disord 7:388–393

    Article  CAS  PubMed  Google Scholar 

  23. Bolender NF, Schonstrom NS, Spengler DM (1985) Role of computed tomography and myelography in the diagnosis of central spinal stenosis. J Bone Joint Surg Am 67:240–246

    Article  CAS  PubMed  Google Scholar 

  24. Senn S (2011) Review of Fleiss, statistical methods for rates and proportions. Res Synth Methods 2:221–222. doi:10.1002/jrsm.50*10.1002/jrsm.50

  25. Ando M, Tamaki T, Kawakami M, Minamide A, Nakagawa Y, Maio K, Enyo Y, Yoshida M (2013) Electrophysiological diagnosis using sensory nerve action potential for the intraforaminal and extraforaminal L5 nerve root entrapment. Eur Spine J 22:833–839. doi:10.1007/s00586-012-2592-5*10.1007/s00586-012-2592-5

  26. Adamova B, Vohanka S, Dusek L (2005) Dynamic electrophysiological examination in patients with lumbar spinal stenosis: is it useful in clinical practice? Eur Spine J 14:269–276. doi:10.1007/s00586-004-0738-9*10.1007/s00586-004-0738-9

  27. Hiraizumi Y, Transfeldt EE, Fujimaki E, Nakabayashi H, Ishikawa T, Sato H (1993) Electrophysiologic evaluation of intermittent sacral nerve dysfunction in lumbar spinal canal stenosis. Spine (Phila Pa 1976) 18:1355–1360

  28. Reinhold M, Ederer C, Henninger B, Eberwein A, Kremser C (2015) Diffusion-weighted magnetic resonance imaging for the diagnosis of patients with lumbar nerve root entrapment syndromes: results from a pilot study. Eur Spine J 24:319–326. doi:10.1007/s00586-014-3602-6

    Article  PubMed  Google Scholar 

  29. Nemoto O, Fujikawa A, Tachibana A (2014) Three-dimensional fast imaging employing steady-state acquisition MRI and its diagnostic value for lumbar foraminal stenosis. Eur J Orthop Surg Traumatol 24(Suppl 1):S209–S214. doi:10.1007/s00590-013-1377-9

    Article  PubMed  Google Scholar 

  30. Fazal A, Yoo A, Bendo JA (2013) Does the presence of the nerve root sedimentation sign on MRI correlate with the operative level in patients undergoing posterior lumbar decompression for lumbar stenosis? SPINE J 13:837–842. doi:10.1016/j.spinee.2013.02.067

    Article  PubMed  Google Scholar 

  31. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331:69–73. doi:10.1056/NEJM199407143310201

    Article  CAS  PubMed  Google Scholar 

  32. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72:403–408

    Article  CAS  PubMed  Google Scholar 

  33. Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, Takiguchi N, Minamide A, Oka H, Kawaguchi H, Nakamura K, Akune T, Yoshida M (2013) Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study. Osteoarthr Cartil 21:783–788. doi:10.1016/j.joca.2013.02.656*10.1016/j.joca.2013.02.656

  34. Barz T, Melloh M, Staub LP, Lord SJ, Lange J, Merk HR (2014) Increased intraoperative epidural pressure in lumbar spinal stenosis patients with a positive nerve root sedimentation sign. Eur Spine J 23:985–990. doi:10.1007/s00586-013-3071-3

    Article  PubMed  Google Scholar 

  35. Moses RA, Zhao W, Staub LP, Melloh M, Barz T, Lurie JD (2015) Is the sedimentation sign associated with spinal stenosis surgical treatment effect in sport? Spine (Phila Pa 1976) 40:129–136. 10.1097/BRS.0000000000000672

  36. Barz T, Staub LP, Melloh M, Hamann G, Lord SJ, Chatfield MD, Bossuyt PM, Lange J, Merk HR (2014) Clinical validity of the nerve root sedimentation sign in patients with suspected lumbar spinal stenosis. Spine J 14:667–674. doi:10.1016/j.spinee.2013.06.105

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the Sun Yat-sen University Clinical Research 5010 Program (Grant Number 2013006).

Author information

Author notes

    Authors and Affiliations

    1. Department of Spine Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China

      Liangming Zhang, Ruiqiang Chen, Bin Liu, Wei Zhang & Limin Rong

    2. Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China

      Yeqing Zhu

    Authors
    1. Liangming Zhang
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Ruiqiang Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Bin Liu
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Wei Zhang
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Yeqing Zhu
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Limin Rong
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Limin Rong.

    Ethics declarations

    Conflict of interest

    No conflicts of interest disclosed.

    Additional information

    L. Zhang and R. Chen contributed equally to this study.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Zhang, L., Chen, R., Liu, B. et al. The nerve root sedimentation sign for differential diagnosis of lumbar spinal stenosis: a retrospective, consecutive cohort study. Eur Spine J 26, 2512–2519 (2017). https://doi.org/10.1007/s00586-016-4435-2

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00586-016-4435-2

    Keywords

    Search

    Navigation