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2013년 9월 21일 토요일

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?

Brief review 1

*Title: 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?

*Authors: Akil Fazal, MD,  Andrew Yoo, BA,  John A. Bendo, MD




BACKGROUND CONTEXT:
-Recent research describes the use of a nerve root sedimentation sign to diagnose lumbar spinal stenosis (LSS).
-The lack of sedimentation of the nerve roots (positive sedimentation sign) to the dorsal part of the dural sac is the characteristic feature of this new radiological parameter.


PURPOSE: To demonstrate how the nerve root sedimentation sign compares with other more traditional radiological parameters in patients who have been operated for LSS.


STUDY DESIGN/SETTING: A retrospective chart and image review.


PATIENT SAMPLE: Preoperative MRI were reviewed from 71 consecutive operative patients who presented with LSS and received spinal decompression surgery (2006-2010).


OUTCOME MEASURES: Preoperative T2-weighted MRIs were reviewed for each patient.


METHODS:
Measurements
134 vertebral levels (L1-5) were measured for
1)     sedimentation sign
2)     cross-sectional area (CSA)
3)     anterior/posterior (A/P) diameter of the dural sac
4)     thickness of the ligamentum flavum
5)     Fujiwara grade of facet hypertrophy.

-using Surgimap 1.1.2.169 software (Nemaris, Inc., New York, NY, USA)

-Exclusion criteria: 1) previous spine surgeries 2) absence of MRI on extended dynamic range 3) surgeries for primary diagnosis other than LSS

Statistical analyses
-using the SPSS 17.0 statistical software (SPSS Inc., Chicago, IL, USA).

-Significance was demonstrated using unpaired t tests and chi-squared tests.


RESULTS: The measurements are listed below.

















CONCLUSIONS:
-The sign is most often present in patients who have clinically significant lumbar stenosis and require surgery.

-The sedimentation sign is a new measurement tool that can enable physicians to objectively assess and quantify spinal stenosis.






*Fujiwara grading system: aim to assess the severity of the facet joint osteoarthritis.