Predictive value of nerve root sedimentation sign in diagnosis of lumbar spinal stenosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Runmin ¹ , TAN Lixian ¹ , DU Xiaokang ² , RONG Limin ¹ ,  ZHANG Liangming ¹

1. Department of Spine Surgery, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510630, P. R. China;
2. Department of Orthopaedics, Wenshang County People’s Hospital, Wenshang Shandong, 272500, P. R. China;

Corresponding author：

ZHANG Liangming, Email: zhanglm36@mail.sysu.edu.cn

Keywords：

Nerve root sedimentation sign; lumbar spinal stenosis; non-specific low back pain; MRI

DOI：

10.7507/1002-1892.202402028

Video：

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Objective To explore the predictive value of the nerve root sedimentation sign in the diagnosis of lumbar spinal stenosis (LSS). Methods Between January 2019 and July 2021, 201 patients with non-specific low back pain (NS-LBP) who met the selection criteria were retrospectively analyzed. There were 67 males and 134 females, with an age of 50-80 years (mean, 60.7 years). Four intervertebral spaces (L_{1, 2}, L_{2, 3}, L_{3, 4}, L_{4, 5}) of each case were studied, with a total of 804. The nerve root sedimentation sign was positive in 126 intervertebral spaces, and central canal stenosis was found in 203 intervertebral spaces. Progression to symptomatic LSS was determined by follow-up for lower extremity symptoms similar to LSS, combined with central spinal stenosis. Univariate analysis was performed for gender, age, visual analogue scale (VAS) score for low back pain at initial diagnosis, treatment, dural sac cross-sectional area at each intervertebral space, number of spinal stenosis segments, lumbar spinal stenosis grade, positive nerve root sedimentation sign, and number of positive segments between patients in the progression group and non-progression group, and logistic regression analysis was further performed to screen the risk factors for progression to symptomatic LSS in patients with NS-LBP. Results All patients were followed up 17-48 months, with an average of 32 months. Of 201 patients with NS-LBP, 35 progressed to symptomatic LSS. Among them, 33 cases also had central spinal stenosis, which was defined as NS-LBP progressing to symptomatic LSS (33 cases in progression group, 168 cases in non-progression group). Univariate analysis showed that CSA at each intervertebral space, the number of spinal stenosis segments, lumbar spinal stenosis grade, whether the nerve root sedimentation sign was positive, and the number of nerve root sedimentation sign positive segments were the influencing factors for the progression to symptomatic LSS (P<0.05); and further logistic regression analysis showed that positive nerve root sedimentation sign increased the risk of progression of NS-LBP to symptomatic LSS (OR=8.774, P<0.001). Conclusion The nerve root sedimentation sign may be associated with the progression of NS-LBP to symptomatic LSS, and it has certain predictive value for the diagnosis of LSS.

Citation： TANG Runmin, TAN Lixian, DU Xiaokang, RONG Limin, ZHANG Liangming. Predictive value of nerve root sedimentation sign in diagnosis of lumbar spinal stenosis. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(5): 550-555. doi: 10.7507/1002-1892.202402028 Copy

1.	中国康复医学会骨质疏松预防与康复专业委员会, 中国老年保健协会骨科微创分会. 退行性腰椎管狭窄症诊疗专家共识. 中华骨与关节外科杂志, 2023, 16(2): 97-103.
2.	Schönnagel L, Zhu J, Camino-Willhuber G, et al. Relationship between lumbar spinal stenosis and axial muscle wasting. Spine J, 2024, 24(2): 231-238.
3.	Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ, 2016, 352: h6234. doi: 10.1136/bmj.h6234.
4.	Walter KL, O’Toole JE. Lumbar spinal stenosis. JAMA, 2022, 328(3): 310. doi: 10.1001/jama.2022.6137.
5.	Banitalebi H, Espeland A, Anvar M, et al. Reliability of preoperative MRI findings in patients with lumbar spinal stenosis. BMC Musculoskelet Disord, 2022, 23(1): 51. doi: 10.1186/s12891-021-04949-4.
6.	Qian G, Wang Y, Huang J, et al. Value of nerve root sedimentation sign in diagnosis and surgical indication of lumbar spinal stenosis. BMC Musculoskelet Disord, 2023, 24(1): 336. doi: 10.1186/s12891-023-06459-x.
7.	Tomkins-Lane CC, Quint DJ, Gabriel S, et al. Nerve root sedimentation sign for the diagnosis of lumbar spinal stenosis: reliability, sensitivity, and specificity. Spine (Phila Pa 1976), 2013, 38(24): E1554-E1560.
8.	Zhang L, Chen R, Xie P, et al. 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, 2015, 44(4): 519-527.
9.	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, 2017, 26(10): 2512-2519.
10.	田洋, 唐超, 廖烨晖, 等. CT和MRI在腰椎管狭窄症中测量椎管面积的一致性和可重复性. 中国组织工程研究, 2021, 25(24): 3882-3887.
11.	Barz T, Melloh M, Staub LP, et al. Nerve root sedimentation sign: evaluation of a new radiological sign in lumbar spinal stenosis. Spine (Phila Pa 1976), 2010, 35(8): 892-897.
12.	Barz T, Staub LP, Melloh M, et al. Clinical validity of the nerve root sedimentation sign in patients with suspected lumbar spinal stenosis. Spine J, 2014, 14(4): 667-674.
13.	Jensen RK, Harhangi BS, Huygen F, et al. Lumbar spinal stenosis. BMJ, 2021, 373: n1581. doi: 10.1136/bmj.n1581.
14.	Cook CJ, Cook CE, Reiman MP, et al. Systematic review of diagnostic accuracy of patient history, clinical findings, and physical tests in the diagnosis of lumbar spinal stenosis. Eur Spine J, 2020, 29(1): 93-112.
15.	Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J, 2013, 13(7): 734-743.
16.	Yang J, Xiong Y, Hu Y, et al. The reliability, correlation with clinical symptoms and surgical outcomes of dural sac cross-sectional area, nerve root sedimentation sign and morphological grade for lumbar spinal stenosis. BMC Musculoskelet Disord, 2023, 24(1): 225. doi: 10.1186/s12891-023-06353-6.
17.	黄志豪, 谢志阳, 吴小涛. 神经根沉降征在腰椎管狭窄症中的研究进展. 中国修复重建外科杂志, 2019, 33(7): 795-800.
18.	Arita S, Ishimoto Y, Hashizume H, et al. Is radiographic lumbar spinal stenosis associated with the quality of life?: The Wakayama Spine Study. PLoS One, 2022, 17(2): e0263930. doi: 10.1371/journal.pone.0263930.
19.	Otani K, Kikuchi SI, Nikaido T, et al. Magnitude of dural tube compression does not show a predictive value for symptomatic lumbar spinal stenosis for 1-year follow-up: a prospective cohort study in the community. Clin Interv Aging, 2018, 13: 1739-1746.
20.	Otani K, Kikuchi SI, Nikaido T, et al. Magnitude of dural tube compression still does not show a predictive value for symptomatic lumbar spinal stenosis for six-year follow-up: A longitudinal observation study in the community. J Clin Med, 2022, 11(13): 3668. doi: 10.3390/jcm11133668.
21.	Zhang Q, Mesregah MK, Patel K, et al. The correlation between negative nerve root sedimentation sign and gravity: A study of upright lumbar multi-positional magnetic resonance images. Global Spine J, 2023, 13(4): 1011-1016.
22.	中国康复医学会脊柱脊髓专业委员会, 中华医学会骨科学分会骨科康复学组. 中国非特异性腰背痛临床诊疗指南. 中国脊柱脊髓杂志, 2022, 32(3): 258-268.
23.	van der Graaf JW, Kroeze RJ, Buckens CFM, et al. MRI image features with an evident relation to low back pain: a narrative review. Eur Spine J, 2023, 32(5): 1830-1841.
24.	Young JJ, Hartvigsen J, Roos EM, et al. Symptoms of lumbar spinal stenosis in people with knee or hip osteoarthritis or low back pain: a cross-sectional study of 10, 234 participants in primary care. Osteoarthritis Cartilage, 2021, 29(11): 1515-1520.
25.	Katz JN, Zimmerman ZE, Mass H, et al. Diagnosis and management of lumbar spinal stenosis: A review. JAMA, 2022, 327(17): 1688-1699.
26.	Enthoven WT, Roelofs PD, Deyo RA, et al. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev, 2016, 2(2): CD012087. doi: 10.1002/14651858.CD012087.
27.	Chou R, Deyo R, Friedly J, et al. Systemic pharmacologic therapies for low back pain: A systematic review for an american college of physicians clinical practice guideline. Ann Intern Med, 2017, 166(7): 480-492.
28.	Minetama M, Kawakami M, Teraguchi M, et al. Supervised physical therapy vs. home exercise for patients with lumbar spinal stenosis: a randomized controlled trial. Spine J, 2019, 19(8): 1310-1318.
29.	Ammendolia C, Côté P, Southerst D, et al. Comprehensive nonsurgical treatment versus self-directed care to improve walking ability in lumbar spinal stenosis: A randomized trial. Arch Phys Med Rehabil, 2018, 99(12): 2408-2419.
30.	Young JJ, Kongsted A, Hartvigsen J, et al. Similar improvements in patient-reported outcomes for non-specific low back pain patients with and without lumbar spinal stenosis symptoms following a structured education and exercise therapy program. BMC Musculoskelet Disord, 2023, 24(1): 839. doi: 10.1186/s12891-023-06950-5.

1. 中国康复医学会骨质疏松预防与康复专业委员会, 中国老年保健协会骨科微创分会. 退行性腰椎管狭窄症诊疗专家共识. 中华骨与关节外科杂志, 2023, 16(2): 97-103.
2. Schönnagel L, Zhu J, Camino-Willhuber G, et al. Relationship between lumbar spinal stenosis and axial muscle wasting. Spine J, 2024, 24(2): 231-238.
3. Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ, 2016, 352: h6234. doi: 10.1136/bmj.h6234.
4. Walter KL, O’Toole JE. Lumbar spinal stenosis. JAMA, 2022, 328(3): 310. doi: 10.1001/jama.2022.6137.
5. Banitalebi H, Espeland A, Anvar M, et al. Reliability of preoperative MRI findings in patients with lumbar spinal stenosis. BMC Musculoskelet Disord, 2022, 23(1): 51. doi: 10.1186/s12891-021-04949-4.
6. Qian G, Wang Y, Huang J, et al. Value of nerve root sedimentation sign in diagnosis and surgical indication of lumbar spinal stenosis. BMC Musculoskelet Disord, 2023, 24(1): 336. doi: 10.1186/s12891-023-06459-x.
7. Tomkins-Lane CC, Quint DJ, Gabriel S, et al. Nerve root sedimentation sign for the diagnosis of lumbar spinal stenosis: reliability, sensitivity, and specificity. Spine (Phila Pa 1976), 2013, 38(24): E1554-E1560.
8. Zhang L, Chen R, Xie P, et al. 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, 2015, 44(4): 519-527.
9. 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, 2017, 26(10): 2512-2519.
10. 田洋, 唐超, 廖烨晖, 等. CT和MRI在腰椎管狭窄症中测量椎管面积的一致性和可重复性. 中国组织工程研究, 2021, 25(24): 3882-3887.
11. Barz T, Melloh M, Staub LP, et al. Nerve root sedimentation sign: evaluation of a new radiological sign in lumbar spinal stenosis. Spine (Phila Pa 1976), 2010, 35(8): 892-897.
12. Barz T, Staub LP, Melloh M, et al. Clinical validity of the nerve root sedimentation sign in patients with suspected lumbar spinal stenosis. Spine J, 2014, 14(4): 667-674.
13. Jensen RK, Harhangi BS, Huygen F, et al. Lumbar spinal stenosis. BMJ, 2021, 373: n1581. doi: 10.1136/bmj.n1581.
14. Cook CJ, Cook CE, Reiman MP, et al. Systematic review of diagnostic accuracy of patient history, clinical findings, and physical tests in the diagnosis of lumbar spinal stenosis. Eur Spine J, 2020, 29(1): 93-112.
15. Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J, 2013, 13(7): 734-743.
16. Yang J, Xiong Y, Hu Y, et al. The reliability, correlation with clinical symptoms and surgical outcomes of dural sac cross-sectional area, nerve root sedimentation sign and morphological grade for lumbar spinal stenosis. BMC Musculoskelet Disord, 2023, 24(1): 225. doi: 10.1186/s12891-023-06353-6.
17. 黄志豪, 谢志阳, 吴小涛. 神经根沉降征在腰椎管狭窄症中的研究进展. 中国修复重建外科杂志, 2019, 33(7): 795-800.
18. Arita S, Ishimoto Y, Hashizume H, et al. Is radiographic lumbar spinal stenosis associated with the quality of life?: The Wakayama Spine Study. PLoS One, 2022, 17(2): e0263930. doi: 10.1371/journal.pone.0263930.
19. Otani K, Kikuchi SI, Nikaido T, et al. Magnitude of dural tube compression does not show a predictive value for symptomatic lumbar spinal stenosis for 1-year follow-up: a prospective cohort study in the community. Clin Interv Aging, 2018, 13: 1739-1746.
20. Otani K, Kikuchi SI, Nikaido T, et al. Magnitude of dural tube compression still does not show a predictive value for symptomatic lumbar spinal stenosis for six-year follow-up: A longitudinal observation study in the community. J Clin Med, 2022, 11(13): 3668. doi: 10.3390/jcm11133668.
21. Zhang Q, Mesregah MK, Patel K, et al. The correlation between negative nerve root sedimentation sign and gravity: A study of upright lumbar multi-positional magnetic resonance images. Global Spine J, 2023, 13(4): 1011-1016.
22. 中国康复医学会脊柱脊髓专业委员会, 中华医学会骨科学分会骨科康复学组. 中国非特异性腰背痛临床诊疗指南. 中国脊柱脊髓杂志, 2022, 32(3): 258-268.
23. van der Graaf JW, Kroeze RJ, Buckens CFM, et al. MRI image features with an evident relation to low back pain: a narrative review. Eur Spine J, 2023, 32(5): 1830-1841.
24. Young JJ, Hartvigsen J, Roos EM, et al. Symptoms of lumbar spinal stenosis in people with knee or hip osteoarthritis or low back pain: a cross-sectional study of 10, 234 participants in primary care. Osteoarthritis Cartilage, 2021, 29(11): 1515-1520.
25. Katz JN, Zimmerman ZE, Mass H, et al. Diagnosis and management of lumbar spinal stenosis: A review. JAMA, 2022, 327(17): 1688-1699.
26. Enthoven WT, Roelofs PD, Deyo RA, et al. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev, 2016, 2(2): CD012087. doi: 10.1002/14651858.CD012087.
27. Chou R, Deyo R, Friedly J, et al. Systemic pharmacologic therapies for low back pain: A systematic review for an american college of physicians clinical practice guideline. Ann Intern Med, 2017, 166(7): 480-492.
28. Minetama M, Kawakami M, Teraguchi M, et al. Supervised physical therapy vs. home exercise for patients with lumbar spinal stenosis: a randomized controlled trial. Spine J, 2019, 19(8): 1310-1318.
29. Ammendolia C, Côté P, Southerst D, et al. Comprehensive nonsurgical treatment versus self-directed care to improve walking ability in lumbar spinal stenosis: A randomized trial. Arch Phys Med Rehabil, 2018, 99(12): 2408-2419.
30. Young JJ, Kongsted A, Hartvigsen J, et al. Similar improvements in patient-reported outcomes for non-specific low back pain patients with and without lumbar spinal stenosis symptoms following a structured education and exercise therapy program. BMC Musculoskelet Disord, 2023, 24(1): 839. doi: 10.1186/s12891-023-06950-5.

Chinese Journal of Reparative and Reconstructive Surgery

Predictive value of nerve root sedimentation sign in diagnosis of lumbar spinal stenosis

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