Research progress on nerve root sedimentation sign of lumbar spinal stenosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Zhihao ¹ , XIE Zhiyang ² ,  WU Xiaotao ²

1. Medicine School of Southeast University, Nanjing Jiangsu, 210000, P.R.China;
2. Department of Spine Surgery, Zhongda Hospital, Southeast University, Nanjing Jiangsu, 210000, P.R.China;

Corresponding author：

WU Xiaotao, Email: wuxiaotaospine@seu.edu.cn

Keywords：

Nerve root sedimentation sign; lumbar spinal stenosis; spinal degeneration

DOI：

10.7507/1002-1892.201904034

Video：

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Objective To summarize the research progress on the nerve root sedimentation sign of lumbar spinal stenosis. Methods The recent domestic and foreign literature in recent years was reviewed. The definition, classification, and mechanism of nerve root sedimentation sign and the relation of nerve root sedimentation sign to diagnosis and treatment of lumbar spinal stenosis were summarized. Results Nerve root sedimentation sign is a phenomena which is found in MRI images of lumbar spine. Its mechanism is mainly increased intraoperative epidural pressure. There are two types of classification and the classification in which nerve root sedimentation sign is classified into " positive” and " negative” is widely applied. It has high sensitivity and specificity in differential diagnosis patients with severe lumbar spinal stenosis and patients with nonspecific low back pain. As for treatment, the nerve root sedimentation sign is related to the surgical disc levels. However, it’s not sure if the nerve root sedimentation sign is related to surgical outcome. In addition, a positive sedimentation sign turns negative after sufficient surgical decompression and a new positive sedimentation sign after sufficient decompression surgery could be used as an indicator of new stenosis in previously operated patients. Conclusion For lumbar spinal stenosis, the nerve root sedimentation sign can be applied as an auxiliary diagnostic indicator, as a guidance for deciding the operated disc levels, and as a postoperative indicator for evaluating the effectiveness.

Citation： HUANG Zhihao, XIE Zhiyang, WU Xiaotao. Research progress on nerve root sedimentation sign of lumbar spinal stenosis. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(7): 795-800. doi: 10.7507/1002-1892.201904034 Copy

1.	Verbiest H. A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg (Br), 1954, 36-B(2): 230-237.
2.	Atlas SJ, Keller RB, D, Robson D, et al. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine (Phila Pa 1976), 2000, 25(5): 556-562.
3.	Resende VAC, Teixeira A, de Silva JB, et al. Lumbar spinal stenosis: sedimentation sign. Coluna/columna, 2013, 12(3): 192-195.
4.	Spivak JM. Degenerative lumbar spinal stenosis. J Bone Joint Surg (Am), 1998, 80(7): 1053-1066.
5.	Lee SY, Kim TH, Oh JK, et al. Lumbar stenosis: a recent update by review of literature. Asian Spine J, 2015, 9(5): 818-828.
6.	Dionne CE, Dunn KM, Croft PR. Does back pain prevalence really decrease with increasing age? A systematic review Age Ageing, 2006, 35(3): 229-234.
7.	de Schepper EIT, Overdevest GM, Pradeep S, et al. Diagnosis of lumbar spinal stenosis: an updated systematic review of the accuracy of diagnostic tests. Spine (Phila Pa 1976), 2013, 38(8): E469-E481.
8.	Andreisek G, Imhof M, Wertli M, et al. A systematic review of semiquantitative and qualitative radiologic criteria for the diagnosis of lumbar spinal stenosis. AJR Am J Roentgenol, 2013, 201(5): W735-W746.
9.	寇福新, 孙常太. 退行性腰椎管狭窄症的治疗进展. 中国脊柱脊髓杂志, 2013, 23(8): 756-759.
10.	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.
11.	Schizas C, Theumann N, Burn A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976), 2010, 35(21): 1919-1924.
12.	陈佳, 赵凤东, 范顺武. 马尾沉降征在腰椎管狭窄症诊断中的价值. 中华骨科杂志, 2015, 35(6): 636-642.
13.	Laudato PA, Kulik G, Schizas C. Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis. Eur Spine J, 2015, 24(10): 2264-2268.
14.	Piechota M, Król R, Elias DA, et al. The nerve root sedimentation sign in diagnosis of lumbar spinal stenosis. Acta Radiologica, 2018, 60(5): 028418511879532.
15.	Macedo LG, Wang Y, Battié MC. The sedimentation sign for differential diagnosis of lumbar spinal stenosis. Spine, 2013, 38(10): 827-831.
16.	柳扬, 包呼日查, 郝敬东, 等. 步行负荷试验与神经根沉降征在腰椎椎管狭窄症中的诊断价值. 脊柱外科杂志, 2016, 14(3): 154-158.
17.	柳扬, 郝敬东, 崔准, 等. 神经根沉降征在中央型腰椎管狭窄症诊断中的初步研究. 中国骨与关节外科, 2016, 9(4): 303-307.
18.	杨军, 洪正华, 王跃. 神经根沉降征及其临床意义的研究进展. 中国脊柱脊髓杂志, 2015, 25(6): 563-566.
19.	Fazal A, Yoo A, Bendo JA. 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, 2013, 13(8): 837-842.
20.	陈延超, 余作冲, 曹蓉, 等. MRI 显示神经根沉降征在腰椎管狭窄症中的应用价值. 中国组织工程研究, 2017, 21(31): 5043-5048.
21.	张楠, 刘娜, 丑凯平, 等. 神经根沉降征与重度中央型/混合型腰椎管狭窄受压节段硬膜囊横截面积变化的相关性研究. 中国脊柱脊髓杂志, 2016, 26(10): 919-925.
22.	杨军, 王章富, 章文杰, 等. 椎管减压术后神经根沉降征的变化研究. 医学研究杂志, 2016, 45(11): 111-114.
23.	Barz T, Melloh M, Staub LP, et al. Increased intraoperative epidural pressure in lumbar spinal stenosis patients with a positive nerve root sedimentation sign. Eur Spine J, 2014, 23(5): 985-990.
24.	Barz C, Melloh M, Staub LP, et al. Reversibility of nerve root sedimentation sign in lumbar spinal stenosis patients after decompression surgery. Eur Spine J, 2017, 26(10): 2573-2580.
25.	田鹏, 付鑫, 孙晓雷, 等. 神经根沉降征在腰椎滑脱症和腰椎间盘突出症中的差异. 天津医药, 2014, 42(12): 1216-1219.
26.	张刚, 高晓平, 陈和木, 等. 神经根沉降征与腰椎间盘突出症的相关性研究. 安徽医药, 2016, 20(5): 883-886.
27.	Yusof MI, Azizan AF, Abdullah MS. Lumbar spinal stenosis: the reliability, sensitivity and specificity of the nerve root sedimentation sign. Malaysian Orthopaedic Journal, 2018, 12(2): 1-6.
28.	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.
29.	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.
30.	Moses RA, Zhao W, Staub LP, et al. Is the sedimentation sign associated with spinal stenosis surgical treatment effect in sport? Spine (Phila Pa 1976), 2015, 40(3): 129-136.
31.	吕永威, 郭继东, 李利, 等. 腰椎管狭窄症伴神经根沉降征阳性患者的疗效观察. 中国医刊, 2016, 51(8): 34-37.
32.	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.
33.	许鹏, 史建刚, 叶晓健, 等. 伴马尾神经沉降征阳性腰椎管狭窄症患者的手术疗效观察. 中国医药导报, 2016, 13(15): 96-99.
34.	Dawood OM, Hassan TA, Mohey N. The MRI finding of the nerve root sedimentation sign: Its clinical validity and operative relativity for patients with lumbar spinal stenosis. Egyptian Journal of Radiology & Nuclear Medicine, 2014, 45(1): 203-209.
35.	Melloh M, Barz T, Staub LP, et al. Is the positive nerve root sedimentation sign in patients with lumbar spinal stenosis reversible after decompression surgery?: GP212 Spine Journal Meeting Abstracts, 2013: 248-249.
36.	敖鹏, 吴添龙, 张磊磊, 等. 神经根沉降征在腰椎管狭窄症术前术后的比较性研究. 中国矫形外科杂志, 2016, 24(19): 1735-1739.

1. Verbiest H. A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg (Br), 1954, 36-B(2): 230-237.
2. Atlas SJ, Keller RB, D, Robson D, et al. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine (Phila Pa 1976), 2000, 25(5): 556-562.
3. Resende VAC, Teixeira A, de Silva JB, et al. Lumbar spinal stenosis: sedimentation sign. Coluna/columna, 2013, 12(3): 192-195.
4. Spivak JM. Degenerative lumbar spinal stenosis. J Bone Joint Surg (Am), 1998, 80(7): 1053-1066.
5. Lee SY, Kim TH, Oh JK, et al. Lumbar stenosis: a recent update by review of literature. Asian Spine J, 2015, 9(5): 818-828.
6. Dionne CE, Dunn KM, Croft PR. Does back pain prevalence really decrease with increasing age? A systematic review Age Ageing, 2006, 35(3): 229-234.
7. de Schepper EIT, Overdevest GM, Pradeep S, et al. Diagnosis of lumbar spinal stenosis: an updated systematic review of the accuracy of diagnostic tests. Spine (Phila Pa 1976), 2013, 38(8): E469-E481.
8. Andreisek G, Imhof M, Wertli M, et al. A systematic review of semiquantitative and qualitative radiologic criteria for the diagnosis of lumbar spinal stenosis. AJR Am J Roentgenol, 2013, 201(5): W735-W746.
9. 寇福新, 孙常太. 退行性腰椎管狭窄症的治疗进展. 中国脊柱脊髓杂志, 2013, 23(8): 756-759.
10. 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.
11. Schizas C, Theumann N, Burn A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976), 2010, 35(21): 1919-1924.
12. 陈佳, 赵凤东, 范顺武. 马尾沉降征在腰椎管狭窄症诊断中的价值. 中华骨科杂志, 2015, 35(6): 636-642.
13. Laudato PA, Kulik G, Schizas C. Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis. Eur Spine J, 2015, 24(10): 2264-2268.
14. Piechota M, Król R, Elias DA, et al. The nerve root sedimentation sign in diagnosis of lumbar spinal stenosis. Acta Radiologica, 2018, 60(5): 028418511879532.
15. Macedo LG, Wang Y, Battié MC. The sedimentation sign for differential diagnosis of lumbar spinal stenosis. Spine, 2013, 38(10): 827-831.
16. 柳扬, 包呼日查, 郝敬东, 等. 步行负荷试验与神经根沉降征在腰椎椎管狭窄症中的诊断价值. 脊柱外科杂志, 2016, 14(3): 154-158.
17. 柳扬, 郝敬东, 崔准, 等. 神经根沉降征在中央型腰椎管狭窄症诊断中的初步研究. 中国骨与关节外科, 2016, 9(4): 303-307.
18. 杨军, 洪正华, 王跃. 神经根沉降征及其临床意义的研究进展. 中国脊柱脊髓杂志, 2015, 25(6): 563-566.
19. Fazal A, Yoo A, Bendo JA. 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, 2013, 13(8): 837-842.
20. 陈延超, 余作冲, 曹蓉, 等. MRI 显示神经根沉降征在腰椎管狭窄症中的应用价值. 中国组织工程研究, 2017, 21(31): 5043-5048.
21. 张楠, 刘娜, 丑凯平, 等. 神经根沉降征与重度中央型/混合型腰椎管狭窄受压节段硬膜囊横截面积变化的相关性研究. 中国脊柱脊髓杂志, 2016, 26(10): 919-925.
22. 杨军, 王章富, 章文杰, 等. 椎管减压术后神经根沉降征的变化研究. 医学研究杂志, 2016, 45(11): 111-114.
23. Barz T, Melloh M, Staub LP, et al. Increased intraoperative epidural pressure in lumbar spinal stenosis patients with a positive nerve root sedimentation sign. Eur Spine J, 2014, 23(5): 985-990.
24. Barz C, Melloh M, Staub LP, et al. Reversibility of nerve root sedimentation sign in lumbar spinal stenosis patients after decompression surgery. Eur Spine J, 2017, 26(10): 2573-2580.
25. 田鹏, 付鑫, 孙晓雷, 等. 神经根沉降征在腰椎滑脱症和腰椎间盘突出症中的差异. 天津医药, 2014, 42(12): 1216-1219.
26. 张刚, 高晓平, 陈和木, 等. 神经根沉降征与腰椎间盘突出症的相关性研究. 安徽医药, 2016, 20(5): 883-886.
27. Yusof MI, Azizan AF, Abdullah MS. Lumbar spinal stenosis: the reliability, sensitivity and specificity of the nerve root sedimentation sign. Malaysian Orthopaedic Journal, 2018, 12(2): 1-6.
28. 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.
29. 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.
30. Moses RA, Zhao W, Staub LP, et al. Is the sedimentation sign associated with spinal stenosis surgical treatment effect in sport? Spine (Phila Pa 1976), 2015, 40(3): 129-136.
31. 吕永威, 郭继东, 李利, 等. 腰椎管狭窄症伴神经根沉降征阳性患者的疗效观察. 中国医刊, 2016, 51(8): 34-37.
32. 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.
33. 许鹏, 史建刚, 叶晓健, 等. 伴马尾神经沉降征阳性腰椎管狭窄症患者的手术疗效观察. 中国医药导报, 2016, 13(15): 96-99.
34. Dawood OM, Hassan TA, Mohey N. The MRI finding of the nerve root sedimentation sign: Its clinical validity and operative relativity for patients with lumbar spinal stenosis. Egyptian Journal of Radiology & Nuclear Medicine, 2014, 45(1): 203-209.
35. Melloh M, Barz T, Staub LP, et al. Is the positive nerve root sedimentation sign in patients with lumbar spinal stenosis reversible after decompression surgery?: GP212 Spine Journal Meeting Abstracts, 2013: 248-249.
36. 敖鹏, 吴添龙, 张磊磊, 等. 神经根沉降征在腰椎管狭窄症术前术后的比较性研究. 中国矫形外科杂志, 2016, 24(19): 1735-1739.

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