Objective: To explore the predictive value of the nerve root sedimentation sign in the diagnosis of lumbar spinal stenosis (LSS).
Methods: Between January 2019 and July 2021, 201 patients with non-specific low back pain (NS-LBP) who met the selection criteria were retrospectively analyzed. There were 67 males and 134 females, with an age of 50-80 years (mean, 60.7 years). Four intervertebral spaces (L 1, 2, L 2, 3, L 3, 4, L 4, 5) of each case were studied, with a total of 804. The nerve root sedimentation sign was positive in 126 intervertebral spaces, and central canal stenosis was found in 203 intervertebral spaces. Progression to symptomatic LSS was determined by follow-up for lower extremity symptoms similar to LSS, combined with central spinal stenosis. Univariate analysis was performed for gender, age, visual analogue scale (VAS) score for low back pain at initial diagnosis, treatment, dural sac cross-sectional area at each intervertebral space, number of spinal stenosis segments, lumbar spinal stenosis grade, positive nerve root sedimentation sign, and number of positive segments between patients in the progression group and non-progression group, and logistic regression analysis was further performed to screen the risk factors for progression to symptomatic LSS in patients with NS-LBP.
Results: All patients were followed up 17-48 months, with an average of 32 months. Of 201 patients with NS-LBP, 35 progressed to symptomatic LSS. Among them, 33 cases also had central spinal stenosis, which was defined as NS-LBP progressing to symptomatic LSS (33 cases in progression group, 168 cases in non-progression group). Univariate analysis showed that CSA at each intervertebral space, the number of spinal stenosis segments, lumbar spinal stenosis grade, whether the nerve root sedimentation sign was positive, and the number of nerve root sedimentation sign positive segments were the influencing factors for the progression to symptomatic LSS ( P<0.05); and further logistic regression analysis showed that positive nerve root sedimentation sign increased the risk of progression of NS-LBP to symptomatic LSS ( OR=8.774, P<0.001).
Conclusion: The nerve root sedimentation sign may be associated with the progression of NS-LBP to symptomatic LSS, and it has certain predictive value for the diagnosis of LSS.
目的: 探索神经根沉降征在腰椎管狭窄症（lumbar spinal stenosis，LSS）诊断中的预测价值。.
方法: 回顾分析2019年1月—2021年7月收治且符合选择标准的201例非特异性腰痛（non-specific low back pain，NS-LBP）患者，其中男67例，女134例；年龄50～80岁，平均60.7岁。研究每例L 1、2、L 2、3、L 3、4、L 4、5椎间隙，共804个；其中126个椎间隙神经根沉降征阳性，203个椎间隙中央椎管狭窄。通过随访是否出现类似LSS的下肢症状，结合是否合并中央椎管狭窄确定患者是否向症状性LSS进展。对进展组和未进展组患者的性别、年龄、初诊时腰部疼痛视觉模拟评分（VAS）评分、治疗情况、各节段椎间隙硬膜囊面积（dural sac cross-sectional area，CSA）、椎管狭窄节段数、腰椎管狭窄分级、神经根沉降征阳性与否、沉降征阳性节段数进行单因素分析，并进一步行logistic回归分析，筛选NS-LBP患者向症状性LSS进展的危险因素。.
结果: 患者均获随访，随访时间17～48个月，平均32个月。201例患者中，35例在初诊至末次随访期间出现过类似LSS的下肢症状，其中33例同时合并中央椎管狭窄（进展组33例，未进展组168例）。单因素分析示各节段椎间隙CSA、椎管狭窄节段数、腰椎管狭窄分级、神经根沉降征阳性与否、沉降征阳性节段数等指标是进展为症状性LSS的影响因素（ P<0.05）；进一步logistic回归分析示，神经根沉降征阳性会增加NS-LBP向症状性LSS进展风险（ OR=8.774， P<0.001）。.
结论: 神经根沉降征阳性可能与NS-LBP进展为症状性LSS相关，对LSS的诊断有一定预测价值。.
Keywords: MRI; Nerve root sedimentation sign; lumbar spinal stenosis; non-specific low back pain.