Title: Clinical validity of the nerve root sedimentation sign in patients with suspected lumbar spinal stenosis
Authors : Barz, Thomas
Staub, Lukas P.
Melloh, Markus
Hamann, Gregor
Lord, Sarah J.
Chatfield, Mark D.
Bossuyt, Patrick M.
Lange, Joern
Merk, Harry R.
Published in : The Spine Journal
Volume(Issue) : 14
Issue : 4
Pages : 667
Pages to: 674
Publisher / Ed. Institution : Elsevier
Publisher / Ed. Institution: Amsterdam
Issue Date: 2014
License (according to publishing contract) : Licence according to publishing contract
Type of review: Not specified
Language : English
Subjects : Lumbar spinal stenosis; Diagnostic test; Sensitivity and specificity; Diagnostic imaging; Nerve root sedimentation
Subject (DDC) : 616.7: Diseases of musculoskeletal system and orthopaedics
617.5: Orthopaedic surgery
Abstract: Background context: The nerve root sedimentation sign in transverse magnetic resonance imaging has been shown to discriminate well between selected patients with and without lumbar spinal stenosis (LSS), but the performance of this new test, when used in a broader patient population, is not yet known. Purpose: To evaluate the clinical performance of the nerve root sedimentation sign in detecting central LSS above L5 and to determine its potential significance for treatment decisions. Study design: Retrospective cohort study. Patient sample: One hundred eighteen consecutive patients with suspected LSS (52% women, median age 62 years) with a median follow-up of 24 months. Outcome measures: Oswestry disability index (ODI) and back and leg pain relief. Methods: We performed a clinical test validation study to assess the clinical performance of the sign by measuring its association with health outcomes. Subjects were patients referred to our orthopedic spine unit from 2004 to 2007 before the sign had been described. Based on clinical and radiological diagnostics, patients had been treated with decompression surgery or nonsurgical treatment. Changes in the ODI and pain from baseline to 24-month follow-up were compared between sedimentation sign positives and negatives in both treatment groups. Results: Sixty-nine patients underwent surgery. Average baseline ODI in the surgical group was 54.7%, and the sign was positive in 39 patients (mean ODI improvement 29.0 points) and negative in 30 (ODI improvement 28.4), with no statistically significant difference in ODI and pain improvement between groups. In the 49 patients of the nonsurgical group, mean baseline ODI was 42.4%; the sign was positive in 18 (ODI improvement 0.6) and negative in 31 (ODI improvement 17.7). A positive sign was associated with a smaller ODI and back pain improvement than negative signs (both p<.01 on t test). Conclusions: In patients commonly treated with decompression surgery, the sedimentation sign does not appear to predict surgical outcome. In nonsurgically treated patients, a positive sign is associated with more limited improvement. In these cases, surgery might be effective, but this needs investigation in prospective randomized trials (Australian New Zealand Clinical Trial Registry, number ACTRN12610000567022).
Departement: Gesundheit
Organisational Unit: Institute of Health Sciences (IGW)
Publication type: Article in scientific Journal
DOI : 10.1016/j.spinee.2013.06.105
ISSN: 1529-9430
URI: https://digitalcollection.zhaw.ch/handle/11475/2578
Appears in Collections:Publikationen Gesundheit

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.