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Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis

Laudato, P. ; Kulik, G. ; Schizas, C.

In: European Spine Journal, 2015, vol. 24, no. 10, p. 2264-2268

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    Title
    • Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis
    Author
    • Laudato, P.. Department of Orthopedics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Avenue Pierre-Decker 4, Lausanne, Switzerland
    • Kulik, G.. Department of Orthopedics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Avenue Pierre-Decker 4, Lausanne, Switzerland
    • Schizas, C.. Neuro-Orthopaedic Spine Unit, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:333125
    Summary
    Purpose: We aimed to study the relationship between two morphological parameters recently described on MRI images in relation to lumbar spinal stenosis (LSS): the first is the sedimentation sign (SedS) and the second is the morphological grading of lumbar stenosis. Materials and methods: MRIs from a total of 137 patients were studied. From those, 110 were issued from a prospective database of symptomatic LSS patients, of whom 73 were treated surgically and 37 conservatively based on symptom severity. A third group consisting of 27 subjects complaining of low back pain (LBP) served as control. Severity of stenosis was judged at disc level using the four A to D grade morphological classification. The presence of a SedS was judged at pedicle level, above or below the site of maximal stenosis. Results: A positive SedS was observed in 58, 69 and 76% of patients demonstrating B, C and D morphology, respectively, but in none with grade A morphology. The SedS was positive in 67 and 35% of the surgically and conservatively treated patients, respectively, and in 8% of the LBP group. C and D morphological grades were present in 97 and 35% of patients in the surgically and conservatively treated group, respectively, and in 18% of the LBP group. Presence of a positive SedS carried an increased risk of being submitted to surgery in the symptomatic LSS group (OR 3.5). This risk was even higher in the LSS patients demonstrating grade C or D morphology (OR 65). Discussion and conclusion: One-third of surgically treated LSS patients do not present a SedS. This sign appears to be a lesser predictor of treatment modality in our setting of symptomatic LSS patients compared to the severity of stenosis judged by the morphological grade.