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, 孫常太. 退行性腰椎管狹窄癥的治療進展. 中國脊柱脊髓雜志, 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.	陳佳, 趙鳳東, 范順武. 馬尾沉降征在腰椎管狹窄癥診斷中的價值. 中華骨科雜志, 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.	柳揚, 包呼日查, 郝敬東, 等. 步行負荷試驗與神經根沉降征在腰椎椎管狹窄癥中的診斷價值. 脊柱外科雜志, 2016, 14(3): 154-158.
17.	柳揚, 郝敬東, 崔準, 等. 神經根沉降征在中央型腰椎管狹窄癥診斷中的初步研究. 中國骨與關節外科, 2016, 9(4): 303-307.
18.	楊軍, 洪正華, 王躍. 神經根沉降征及其臨床意義的研究進展. 中國脊柱脊髓雜志, 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.	陳延超, 余作沖, 曹蓉, 等. MRI 顯示神經根沉降征在腰椎管狹窄癥中的應用價值. 中國組織工程研究, 2017, 21(31): 5043-5048.
21.	張楠, 劉娜, 丑凱平, 等. 神經根沉降征與重度中央型/混合型腰椎管狹窄受壓節段硬膜囊橫截面積變化的相關性研究. 中國脊柱脊髓雜志, 2016, 26(10): 919-925.
22.	楊軍, 王章富, 章文杰, 等. 椎管減壓術后神經根沉降征的變化研究. 醫學研究雜志, 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.	田鵬, 付鑫, 孫曉雷, 等. 神經根沉降征在腰椎滑脫癥和腰椎間盤突出癥中的差異. 天津醫藥, 2014, 42(12): 1216-1219.
26.	張剛, 高曉平, 陳和木, 等. 神經根沉降征與腰椎間盤突出癥的相關性研究. 安徽醫藥, 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.	呂永威, 郭繼東, 李利, 等. 腰椎管狹窄癥伴神經根沉降征陽性患者的療效觀察. 中國醫刊, 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.	許鵬, 史建剛, 葉曉健, 等. 伴馬尾神經沉降征陽性腰椎管狹窄癥患者的手術療效觀察. 中國醫藥導報, 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.	敖鵬, 吳添龍, 張磊磊, 等. 神經根沉降征在腰椎管狹窄癥術前術后的比較性研究. 中國矯形外科雜志, 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, 孫常太. 退行性腰椎管狹窄癥的治療進展. 中國脊柱脊髓雜志, 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. 陳佳, 趙鳳東, 范順武. 馬尾沉降征在腰椎管狹窄癥診斷中的價值. 中華骨科雜志, 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. 柳揚, 包呼日查, 郝敬東, 等. 步行負荷試驗與神經根沉降征在腰椎椎管狹窄癥中的診斷價值. 脊柱外科雜志, 2016, 14(3): 154-158.
17. 柳揚, 郝敬東, 崔準, 等. 神經根沉降征在中央型腰椎管狹窄癥診斷中的初步研究. 中國骨與關節外科, 2016, 9(4): 303-307.
18. 楊軍, 洪正華, 王躍. 神經根沉降征及其臨床意義的研究進展. 中國脊柱脊髓雜志, 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. 陳延超, 余作沖, 曹蓉, 等. MRI 顯示神經根沉降征在腰椎管狹窄癥中的應用價值. 中國組織工程研究, 2017, 21(31): 5043-5048.
21. 張楠, 劉娜, 丑凱平, 等. 神經根沉降征與重度中央型/混合型腰椎管狹窄受壓節段硬膜囊橫截面積變化的相關性研究. 中國脊柱脊髓雜志, 2016, 26(10): 919-925.
22. 楊軍, 王章富, 章文杰, 等. 椎管減壓術后神經根沉降征的變化研究. 醫學研究雜志, 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. 田鵬, 付鑫, 孫曉雷, 等. 神經根沉降征在腰椎滑脫癥和腰椎間盤突出癥中的差異. 天津醫藥, 2014, 42(12): 1216-1219.
26. 張剛, 高曉平, 陳和木, 等. 神經根沉降征與腰椎間盤突出癥的相關性研究. 安徽醫藥, 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. 呂永威, 郭繼東, 李利, 等. 腰椎管狹窄癥伴神經根沉降征陽性患者的療效觀察. 中國醫刊, 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. 許鵬, 史建剛, 葉曉健, 等. 伴馬尾神經沉降征陽性腰椎管狹窄癥患者的手術療效觀察. 中國醫藥導報, 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. 敖鵬, 吳添龍, 張磊磊, 等. 神經根沉降征在腰椎管狹窄癥術前術后的比較性研究. 中國矯形外科雜志, 2016, 24(19): 1735-1739.

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