Correlation Between Nerve Root Sedimentation Sign And Lumbar Curvature And Its Clinical Significance

Objective:LSS?lumbar spinal stenosis?,originally described by Verbiest^[1]in 1954,has become one of the most common surgical diseases affecting our aging population^[2],currently on lumbar spinal stenosis There is no consensus on imaging diagnostic criteria.Some diagnostic methods for imaging,in particular,the reduction of CSA?cross-sectional area?has been accepted as an indicator for the differential diagnosis of lumbar spinal stenosis^[3.4].However,the use of CSA as a diagnostic tool is not ideal.In2010,Barz et al^[7]introduced NRSS?Nerve root sedimentation sign?as an imaging tool for LSS diagnosis,showing better sensitivity..There are related studies on the causes of subsidence sign,such as increased epidural pressure and neuro inflammatory reaction,but there is no conclusion.In all patients with LSS,not all patients have positive NRSS,what is the reason?We have found that some scholars in China have proposed the concept of"neural root bowstring disease".The positive nerve root sedimentation sign is an important diagnostic basis.It has achieved good clinical practice through the treatment of lumbar capsule shortening and changes in lumbar curvature.Effect^[8].Based on clinical experience and literature,we believe that nerve root depression has a good value in the diagnosis of lumbar spinal stenosis.At the same time,the biomechanical parameters related to the curvature of the lumbar spine have a strong correlation with the occurrence and treatment of lumbar vertebrae-related diseases.There is no research on the relationship between nerve root subsidence and lumbar curvature.We suspect that lumbar curvature factor is one of the reasons for the difference in the realization of NRSS in patients with LSS.This study proposes to validate the conjecture,enrich the explanation for the cause of NRSS,and provide a basis for the targeted adjustment of the lumbar curvature in the relevant LSS patients with NRSS-positive surgical procedures.Method:A retrospective analysis of 56 patients with degenerative lumbar spinal stenosis and a lumbar supine magnetic resonance imaging in the Department of Spinal Surgery,The Second Hospital Of Dalian Medical University,from October 2017 to December 2018.There were 18 males,aged 58-87 years,mean?66.8±6.67?years old,38 females,aged 53-82 years,mean?66.6±7.81?years old.According to the positive or negative signs of lumbar nerve root remodeling in magnetic resonance imaging,they were divided into two groups:NRSS?-??n=17?and NRSS?+??n=39?,which were independently performed by three spine surgeons.The nerve root settlement and lumbar curvature parameters were calculated by the same method.The measurement data conforming to the normal distribution was described by the relationship x±s.The difference between the groups was compared using the independent sample t test,and the classification data was described by percentage.The difference between the variables was compared using the X² test.The sensitivity of the diagnosis of lumbar spinal stenosis was calculated by symptomatic diagnosis as the"gold standard".The age,sex,time of neurogenic claudication,walking distance before claudication,minimum dural capsule cross-sectional area?MCSA?in lumbar spine magnetic resonance,and median sagittal mid-lumbar curvature angle were compared between the two groups.?Cobb angle?,lumbar curvature index?LCI?,sacral tilt angle?SSA?,a nd Harrison vertebral tangential angle were statistically different.Results:1.Baseline data analysis:According to the degenerative LSS symptomological diagnosis as the standard,a total of 56 patients were included,all of which were included in the analysis of results,without shedding.NRSS?-?,NRSS?+?group of patients with lumbar spinal stenosis age,gender,time of neurogenic claudication,walking distance before claudication,minimum dural capsule cross-sectional area in lumbar spine magnetic resonance(MCSA There was no significant significance.After t test and X² test,P>0.05.2.Sensitivity of nerve root settlement syndrome:Among all 56 patients diagnosed with LSS by symptomology,17 patients in the NRSS?-?group and 39 patients in the NRSS?+?group were positive for nerve root settlement as a diagnosis of LSS.Diagnostic indicators with a sensitivity of 69.7%.3.Comparison of lumbar curvature parameters:NRSS?-?,NRSS?+?patients with lumbar spinal stenosis in the MRI median sagittal plane Cobb angle,LCI,SSA,Harrison vertebral tangential angle difference Sexual significance,after t test,P<0.05.Among the NRSS?+?group,four indicators showed that the group showed smaller lumbar curvature.4,lumbar curvature scatter distribution map:LCI and Cobb angle,SSA and Harrison vertebral body tangential angle for the lumbar curvature scatter distribution map,when the index of the four lumbar curvature decreases,NRSS?+?group The proportion is significantly increased.Conclusion:The nerve root sedimentation sign has a good sensitivity to the diagnosis of lumbar spinal stenosis,reaching 69.7%.In patients with lumbar spinal stenosis,the signs of nerve root sedimentation are correlated with parameters related to lumbar curvature.In patients with lumbar spinal stenosis with reduced lumbar curvature,the sign of subsidence is more likely to be positive.It is suggested that the curvature of the lumbar vertebrae may be one of the causes of nerve root subsidence in patients with lumbar spinal stenosis.In addition,we suspect that for patients with lumbar spinal stenosis with positive nerve root sedimentation sign,the lumbar vertebrae should be appropriately increased when surgery is performed.The curvature can help to change the positive sign of nerve root settlement to negative,and improve the satisfaction of surgery.