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Abstract

BACKGROUND: Lumbar nerve roots normally sediment, due to gravity, to the dorsal part of the dural sac, which is known as negative sedimentation sign. If there is a magnetic resonance finding of nerve roots in  the ventral part of the dural sac the sedimentation sign is positive. OBJECTIVE: To evaluate the presence of the MRI finding of positive sedimentation sign in patients clinically suspected to have lumbar spinal stenosis and if this sign can be a valid tool to differentiate  symptomatic spinal canal stenosis from other causes of non-specific back pain. METHODS: A planned cohort design prospective study had conducted over a year through July 2019 at the department of neurosurgery at Medical City / Baghdad / Iraq. The study incorporates 200 patients. Those with symptomatic lumbar spine canal stenosis (n=100) show claudication with or without low back pain, leg pain, a dural sac cross-sectional area < 80 mm2, and a walking interval < 200 meters. The nonspecific low back pain group (n=100) had no leg pain, no claudication, a cross-sectional area of the dural sac >120 mm2, and a walking interval >1000 meters. The frequency of a positive sedimentation sign compared between both groups to evaluate if this sign can be a valid tool to differentiate spinal canal stenosis from other causes of back pain, intra-rater and inter-rater assessment dependability in a stochastic subsample executed. RESULTS: A positive sedimentation sign recognized in 96 patients in the symptomatic lumbar spine canal stenosis group (96%; 95% Confidence Interval CI, 90%–98%), no positive sedimentation sign recognized in the nonspecific low back pain group (0%; 95% Confidence Interval CI, 0%–5%). Credibility was Kappa (ĸ) =1.0 (intra-rater) and Kappa (ĸ) =0.90 (inter-rater), in sequence. CONCLUSION:  A positive sedimentation sign is dependably seen in lumbar spine canal stenosis cases, recommending its value in clinical application.  

DOI

10.52573/ipmj.2020.168630

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