| ObjectiveWe aimed to study the relationship between two morphological parameters recently described on the cross-section of MRI image in relation to degenerative lumbar spinal stenosis(DLSS):the sedimentation sign(SedS) and the four morphological grading of lumbar stenosis, and to determine if sedimentation sign on MRI can help with DLSS treatment decision and prognosis.MethodsEighty patients with degenerative lumbar spinal stenosis who were undergoing treatment of in-or out-patient in Guangdong Province Hospital of Traditional Chinese Medicine from January 2012 to February 2014 were analyzed retrospectively(40 surgical treatment,40 conservative treatment). The MRI images of all patients were recorded and documented in electronic medical imaging system (Huahai imaging system).Surgery group (n=40), age from 53 to 84, with the average of 64.68±8.547 and among them with 24 males,16 females. These patients in the hospital undertook decompression and fusion surgery, were recorded in hospital time(d), intra-operative blood loss (ml), operation time(min) and complications of clinical data; non-operative group (n=40), age from 42 to 78, with the average of 63.25±8.252 and among them with 21 males, 19 females. Non-surgical outpatients or hospitalization were treated conservatively for at least six months or more. Observation and follow-up of two groups patients before and after treatment. The clinical outcomes of visual analog scale(VAS) andOswestry low back pain disability questionaire index (ODI) were recorded and used SPSS 23.0 software for statistical analysis. ResultsA positive SedS was observed in 53.8(7/13)、62.1(18/29)、65.2%(15/23) patients demonstrating B, C and D morphology, respectively, but in none with grade A and D morphology. The positive SedS in 65(26/40) and 35%(14/40) of the surgically and non-surgically treated patients, respectively. C and D morphological grades were present in 95 and 35%of patients in the surgically and non-surgically, respectively. Presence of a positive SedS carried an increased risk of being submitted to surgery in the degenerative lumbar spinal stenosis (OR 3.45). This risk was even higher in the LSS patients demonstrating grade C or D morphology. In treatment to improve the situation, the surgery group improved better than non-operation group, the improvement of differences exist obvious statistical difference (P< 0.01). In the surgical group, positive group of SedS improve better than negative group (P< 0.05), and improvement of positive group on lower extremity pain and ODI compared with the negative group was more obvious, hospitalization and follow-up showed no obvious complications; In non-operative treatment group between positive and negative group there was no obvious statistical difference (P> 0.05).ConClutionThe sedimentation sign is proposed in recent years as a tool and assistant for diagnosis of symptomatic lumbar spinal stenosis. The positive sign is more inclined to the morphological C or D grade; but this sign appears to be a lesser predictor of treatment modality in our setting of symptomatic lumbar spinal stenosis patients compared to the severity of stenosis judged by the morphological grade. After adjusting for other demographic and imaging features, a positive sedimentation sign was associated with a small but significantly greater surgical treatment effect for Oswestry Disability Index in patients with degenerative lumbar spinal stenosis. This findings suggest that positive sedimentation sign may potentially be a usefully adjunct to help guide an informed treatment choice regarding sugary for lumbar spinal stenosis. |
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