scholarly journals The Correlation Between Negative Nerve Root Sedimentation Sign and Gravity: A Study of Upright Lumbar Multi-Positional Magnetic Resonance Images

2021 ◽  
pp. 219256822110133
Author(s):  
Qiwen Zhang ◽  
Mohamed Kamal Mesregah ◽  
Kishan Patel ◽  
Zorica Buser ◽  
Jeffrey C. Wang
Keyword(s):  
Nerve Root ◽  
Magnetic Resonance Images ◽  
Upright Position ◽  
Nerve Roots ◽  
Cross Sectional ◽  
Upright Mri ◽  
Observer Reliability ◽  
Positional Mri ◽  
Dural Sac ◽  
The Relationship

Study Design: Retrospective upright MRI study. Objective: To validate the presence of positive and negative nerve root sedimentation signs on multi-positional MRI in the upright position and explore the relationship between negative nerve root sedimentation and gravity. Methods: T2-weighted axial multi-positional images in the upright position at the intervertebral disc levels from L1–L2 to L4–L5 in 141 patients with non-specific low back pain were retrospectively assessed. A positive sedimentation sign was defined as the absence of nerve root sedimentation or the absence of dorsal conglomeration of nerve roots within the dural sac. A negative sedimentation sign was defined as nerve root sedimentation dorsally or dorso-laterally like a horseshoe. Intra-and inter-observer reliability was evaluated. The relationship between sedimentation sign and dural sac cross-sectional area (CSA), anterior-posterior (AP) diameter was also explored. Results: The kappa value of intra-observer reliability was 0.962 and inter-observer reliability was 0.925. Both positive and negative sedimentation signs did appear at all 4 lumbar levels, including L1/2, L2/3, L3/4 and L4/5. A positive sedimentation sign was associated with significantly decreased dural sac CSA and AP diameter at L2/3, L3/4 or L4/5 level when compared to negative sedimentation sign. Conclusions: Both negative and positive sedimentation signs appeared at the L1/2, L2/3, L3/4, and L4/5 levels on the upright MRI, which suggested that the presence of nerve roots sedimenting dorsally in patients may not be associated with gravity. Moreover, the current study supports that sedimentation signs on multi-positional MRI images could have the same diagnostic functions as on MRI images.

scholarly journals Gravity determines the direction of nerve roots sedimentation in the lumbar spinal canal

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jun Yang ◽  
Zhiyun Feng ◽  
Nian Chen ◽  
Zhenhua Hong ◽  
Yongyu Zheng ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Mr Imaging ◽  
Spinal Canal ◽  
Ventral Side ◽  
Lateral Position ◽  
Dorsal Side ◽  
Mr Images ◽  
Nerve Roots ◽  
Cross Sectional ◽  
Dural Sac

Abstract Objectives To investigate the role of gravity in the sedimentation of lumbar spine nerve roots using magnetic resonance (MR) imaging of various body positions. Methods A total of 56 patients, who suffered from back pain and underwent conventional supine lumbar spine MR imaging, were selected from sanmen hospital database. All the patients were called back to our hospital to perform MR imaging in prone position or lateral position. Furthermore, the sedimentation sign (SedSign) was determined based on the suspension of the nerve roots in the dural sac on cross-sectional MR images, and 31 cases were rated as positive and another 25 cases were negative. Results The mean age of negative SedSign group was significantly younger than that of positive SedSign group (51.7 ± 8.7 vs 68.4 ± 10.5, P < 0.05). The constitutions of clinical diagnosis were significantly different between patients with a positive SedSign and those with a negative SedSign (P < 0.001). Overall, nerve roots of the vast majority of patients (48/56, 85.7%) subsided to the ventral side of the dural sac on the prone MR images, although that of 8 (14.3%) patients remain stay in the dorsal side of dural sac. Nerve roots of only one patient with negative SedSign did not settle to the ventral dural sac, while this phenomenon occurred in 7 patients in positive SedSign group (4% vs 22.6%, P < 0.001). In addition, the nerve roots of all the five patients subsided to the left side of dural sac on lateral position MR images. Conclusions The nerve roots sedimentation followed the direction of gravity. Positive SedSign may be a MR sign of lumbar pathology involved the spinal canal.

scholarly journals Cauda equina redundant nerve roots are associated to the degree of spinal stenosis and to spondylolisthesis

2014 ◽  
Vol 72 (10) ◽  
pp. 782-787 ◽  
Author(s):  
Leonor Garbin Savarese ◽  
Geraldo Dias Ferreira-Neto ◽  
Carlos Fernando Pereira da Silva Herrero ◽  
Helton Luiz Aparecido Defino ◽  
Marcello H. Nogueira-Barbosa
Keyword(s):  
Spinal Stenosis ◽  
Cauda Equina ◽  
Intervertebral Discs ◽  
Observer Agreement ◽  
Nerve Roots ◽  
Cross Sectional ◽  
Dural Sac ◽  
Increased Risk ◽  
Independent Risk Factors ◽  
Lumbar Spinal

To evaluate the association of redundant nerve roots of cauda equina (RNRCE) with the degree of lumbar spinal stenosis (LSS) and with spondylolisthesis. Method After Institutional Board approval, 171 consecutive patients were retrospectively enrolled, 105 LSS patients and 66 patients without stenosis. The dural sac cross-sectional area (CSA) was measured on T2w axial MRI at the level of L2-3, L3-4 and L4-5 intervertebral discs. Two blinded radiologists classified cases as exhibiting or not RNRCE in MRI. Intra- and inter-observer reproducibility was assessed. Results RNRCE were associated with LSS. RRNCE was more frequent when maximum stenosis<55 mm2. Substantial intra- observer agreement and moderate inter-observer agreement were obtained in the classification of RNRCE. Spondylolisthesis was identified in 27 patients and represented increased risk for RRNCE. Conclusion LSS is a risk factor for RNRCE, especially for dural sac CSA<55 mm2. LSS and spondylolisthesis are independent risk factors for RNRCE.

Spinal Dural Sac, Nerve Root Cuffs, Rootlets, and Nerve Roots

2014 ◽  
pp. 385-409
Author(s):  
Miguel Angel Reina ◽  
Anna Oliva ◽  
Anna Carrera ◽  
Jorge Diamantopoulos ◽  
Alberto Prats-Galino
Keyword(s):  
Nerve Root ◽  
Nerve Roots ◽  
Dural Sac

scholarly journals Spinal subarachnoid space tapering in patients with syringomyelia

2019 ◽  
Vol 32 (5) ◽  
pp. 382-385
Author(s):  
Emily Rutan ◽  
Neel Madan ◽  
Ryan Zea ◽  
Victor Haughton
Keyword(s):  
Cervical Spine ◽  
Spinal Canal ◽  
Statistical Significance ◽  
Magnetic Resonance Images ◽  
Cross Sectional ◽  
Dural Sac ◽  
Anteroposterior Diameter ◽  
Spinal Subarachnoid Space ◽  
Chiari I ◽  
And Control

Background and purpose Cervical spine tapering affects cerebrospinal fluid dynamics. Cervical spine taper ratios derived from anteroposterior diameters reportedly differ between patients with syringomyelia and controls. We attempted to verify the differences in diameter and to show differences in cross-sectional area between syringomyelia and controls. Methods Cervical spine magnetic resonance images in syringomyelia patients (idiopathic or Chiari I related) and control patients were examined. In each subject, the anteroposterior diameter of the spinal canal was measured at each cervical level, and C1–C4, C4–C7, and C1–C7 taper ratios were calculated. Differences in taper ratio between groups were tested for statistical significance with the t-test. Cross-sectional areas of the spinal canal were measured at each cervical spinal level, and tapering was calculated. Results Eighteen patients with idiopathic syringomyelia, 28 with Chiari I, and 29 controls were studied. Chiari and syringomyelia patients had significantly steeper diameter-based taper ratios than controls. The dural sac areas tapered proportionally with the diameter-based taper ratio in all groups. Conclusions Cervical spine anteroposterior diameter tapering and dural sac cross-sectional areas tapering differ between syringomyelia patients and controls.

Extradural Characteristics of the Origins of Lumbosacral Nerve Roots

2018 ◽  
Vol 80 (02) ◽  
pp. 109-115 ◽  
Author(s):  
Viktor Matejcik ◽  
Roman Kuruc ◽  
Ján Líška ◽  
Juraj Steno ◽  
Zora Haviarova
Keyword(s):  
Nerve Root ◽  
Spinal Nerve ◽  
Intervertebral Foramen ◽  
Nerve Roots ◽  
Lumbosacral Region ◽  
Dural Sac ◽  
Comprehensive Knowledge ◽  
Different Types ◽  
Herniated Disk ◽  
Sacral Hiatus

Background and Study Aims A great number of unsuccessful intervertebral herniated disk surgeries in the lumbosacral region have highlighted the importance of a comprehensive knowledge of the different types of nerve root anomalies. That knowledge gained by anatomical studies (and intraoperative findings) might contribute to better results. In our study we focused on intraspinal extradural lumbosacral nerve root anomalies and their possible role in radiculopathy. Material and Methods The study was performed on 43 cadavers within 24 hours after death (32 men and 11 women). Bodies were dissected in the prone position, and a laminectomy exposed the entire spinal canal for the bilateral examination of each spinal nerve root from its origin to its exit through the intervertebral foramen or sacral hiatus. Uncommon extradural features in the lumbosacral region were pursued and documented. The spinal dural sac was also opened, aimed at recognizing the normotyped, prefixed, or postfixed type of plexus. Results A total of 20.93% of anomalies of extradural lumbosacral nerve root origins were observed, with the normotyped plexus prevailing. We observed atypical spacing of exits of lumbosacral roots (four cases), two roots leaving one intervertebral foramen (one case), extradural anastomoses (two cases), and missing extradural nerve root courses (two cases). The results were differentiated according to the normotyped, prefixed, or postfixed plexus type. Conclusion Results of similar studies dealing with anomalies of lumbosacral nerve roots were aimed at improving the results of herniated disk surgeries because ∼ 10% of misdiagnoses are related to ignorance of anatomical variability. Our observations may help explain the differences between the clinical picture and generally accepted anatomical standards.

scholarly journals Where do patients with MRI-confirmed single-level radiculopathy experience pain, and what is the clinical interpretability of these pain patterns? A cross-sectional diagnostic accuracy study

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Hanne B. Albert ◽  
Jeanette Kaae Hansen ◽  
Helle Søgaard ◽  
Peter Kent
Keyword(s):  
Diagnostic Accuracy ◽  
Nerve Root ◽  
Radicular Pain ◽  
Leg Pain ◽  
Nerve Root Compression ◽  
Diagnostic Accuracy Study ◽  
Nerve Roots ◽  
Cross Sectional ◽  
Single Level ◽  
Accuracy Study

Abstract Background Clinicians nominate the distribution of leg pain as being important in diagnosing nerve root involvement. This study aimed to identify: (i) common unisegmental radicular pain patterns and whether they were dermatomal, and (ii) whether these radicular pain patterns assisted clinician discrimination of the nerve root level involved. Methods A cross-sectional diagnostic accuracy study of adult patients with radicular leg pain at a hospital in Denmark. All patients had positive neurological signs (average 2.8 signs - hypoalgesia, diminished reflexes, muscle weakness, positive Straight Leg Raise test). Part 1 (pain patterns) was a secondary analysis of baseline pain pattern data collected during a clinical trial. The pain charts of 93 patients with an MRI and clinically confirmed single-level disc herniation with nerve root compression were digitised and layered to form a composite picture of the radicular patterns for the L5 and S1 nerve roots, which were then compared to published dermatomes. In Part 2 (clinical utility) we prospectively measured the discriminative ability of the identified pain patterns. The accuracy was calculated of three groups of six clinicians at classifying the nerve root affected in a randomized sequence of 53 patients, when not shown, briefly shown or continuously shown the composite pain patterns. In each group were two chiropractors, two medical doctors and two physiotherapists. Results There was a wide overlap in pain patterns from compromised L5 and S1 nerve roots but some distinguishing features. These pain patterns had approximately 50 to 80% overlap with published dermatomes. Clinicians were unable to determine with any accuracy above chance whether an individual pain drawing was from a person with a compromised L5 or S1 nerve root, and use of the composite pain drawings did not improve that accuracy. Conclusions While pain distribution may be an indication of radiculopathy, pain patterns from L5 or S1 nerve root compression only approximated those of sensory dermatomes, and level-specific knowledge about radicular pain patterns did not assist clinicians’ diagnostic accuracy of the nerve root impinged. These results indicate that, on their own, pain patterns provide very limited additional diagnostic information about which individual nerve root is affected.

scholarly journals Ipsilateral S2 nerve root transfer to pudendal nerve for restoration of external anal and urethral sphincter function: an anatomical study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Lei Zhu ◽  
Zhi-bin Zhou ◽  
Di Shen ◽  
Ai-min Chen
Keyword(s):  
Nerve Root ◽  
Sural Nerve ◽  
Pudendal Nerve ◽  
Nerve Graft ◽  
Urethral Sphincter ◽  
Sacral Plexus ◽  
Nerve Roots ◽  
Cross Sectional ◽  
Sphincter Function ◽  
Sural Nerve Graft

Abstract Patients suffer bilateral sacral plexus injuries experience severe problems with incontinence. We performed a cadaveric study to explore the anatomical feasibility of transferring ipsilateral S2 nerve root combined with a sural nerve graft to pudendal nerve for restoration of external anal and urethral sphincter function. The sacral nerve roots and pudendal nerve roots on the right side were exposed in 10 cadavers. The length from S2 nerve root origin to pudendal nerve at inferior border of piriformis was measured. The sural nerve was used as nerve graft. The diameters and nerve cross-sectional areas of S2 nerve root, pudendal nerve and sural nerve were measured and calculated, so as the number of myelinated axons of three nerves on each cadaver specimen. The length from S2 nerve root to pudendal nerve was 10.69 ± 1.67 cm. The cross-sectional areas of the three nerves were 8.57 ± 3.03 mm2 for S2, 7.02 ± 2.04 mm2 for pudendal nerve and 6.33 ± 1.61 mm2 for sural nerve. The pudendal nerve contained approximately the same number of axons (5708 ± 1143) as the sural nerve (5607 ± 1305), which was a bit less than that of the S2 nerve root (6005 ± 1479). The S2 nerve root in combination with a sural nerve graft is surgically feasible to transfer to the pudendal nerve for return of external urethral and anal sphincter function, and may be suitable for clinical application in patients suffering from incontinence following sacral plexus injuries.

scholarly journals Gravity Determines the Direction of Nerve Roots Sedimentation in the Lumbar Spinal Canal

2020 ◽  
Author(s):  
Jun Yang ◽  
Zhiyun Feng ◽  
Zhenhua Hong ◽  
Jiang Yang ◽  
Tingjie Zhou ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Mr Imaging ◽  
Spinal Canal ◽  
Body Position ◽  
Lateral Position ◽  
Dorsal Side ◽  
Mr Images ◽  
Nerve Roots ◽  
Cross Sectional ◽  
Dural Sac

Abstract Objectives: To investigate the role of gravity in the sedimentation of lumbar spine nerve roots using magnetic resonance (MR) imaging of various body position. Methods: A total of 56 patients suffered from back pain and underwent conventional supine lumbar spine MR imaging were selected from sanmen hospital database. All the patients were called back to our hospital to perform MR imaging in prone position or lateral position. Furthermore, the sedimentation sign (SedSign) was determined based on the suspension of the nerve roots in the dural sac on cross-sectional MR images, and 31 cases were rated as positive and another 25 cases were negative. Results: The mean age of negative SedSign group was significantly younger than that of positive SedSign group (51.7±8.7 vs 68.4±10.5, P<0.05). The constitutions of clinical diagnosis were significantly different between patients with a positive SedSign and those with a negative SedSign (P<0.001). Overall, nerve roots of the vast majority of patients (48/56, 85.7%) subsided to the ventral side of the dural sac on the prone MR images, although that of 8 (14.3%) patients remain stay in the dorsal side of dural sac. Nerve roots of only one patient with negative SedSign did not settle to the ventral dural sac, while this phenomenon occurred in 7 patients in positive SedSign group (4% vs 22.6%, P<0.001). In addition, the nerve roots of all the five patients subsided to the left side of dural sac on lateral position MR images. Conclusions: The nerve roots sedimentation followed the direction of gravity. Positive SedSign, floating of nerve roots in the canal, may be a MR sign of lumbar pathology involved the spinal canal.

scholarly journals Relative risk factors of nerve root sedimentation sign (Sedsign) in patients with severe central lumbar spinal stenosis (LSS)

2021 ◽  
Author(s):  
Haiming YU ◽  
Yunfeng HAN ◽  
Rui ZHANG ◽  
Chu SUN ◽  
Mingda WANG ◽  
...  
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Nerve Root ◽  
Sectional Area ◽  
Cross Sectional ◽  
Dural Sac ◽  
Significant Difference ◽  
Lumbar Spinal

Abstract Here we evaluated the incidence of positive nerve root sedimentation sign (Sedsign) and its correlation with MRI parameters in patients with severe lumbar spinal stenosis (LSS) to explore its pathogenesis. Among 209 patients with severe LSS, there were 290 levels with intervertebral narrowing, among which 248 had a positive Sedsign (a prevalence of 85.52%). We then analyzed those levels with a positive Sedsign relative to those with a negative Sedsign (42 levels). There was no significant difference between the two groups for the minimum cross-sectional area (CSA) of the dural sac or the minimum posteroanterior diameter (PAD) of the spinal canal. In contrast, there was a significant difference between the groups for the grade of degenerative facet joint (DFJ) (p < 0.05), the maximum thickness of ligamentum flavum (TLF) (p < 0.01), and the maximum cross-sectional area difference (CSAD) of the dural sac (p < 0.01). In addition, receiver operating characteristic (ROC) curves were used to identify associated factors. The area under the ROC curve for PAD was 0.608 (95%CI: 0.55−0.665, p < 0.05), for DFJ was 0.634 (95%CI: 0.576−0.69, p < 0.05), for TLF was 0.74 (95%CI: 0.742−0.839, p < 0.01), and for CSAD was 0.911 (95%CI: 0.875−0.943, p < 0.01). In summary, a positive Sedsign has notable advantages in assisting with the diagnosis of severe LSS. Compression of the dural sac from the rear may be the main cause of a positive Sedsign, and the TLF and DFJ parameters were the main relative risk factors.

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