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

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, 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.

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

10.21203/rs.3.rs-54612/v1 ◽

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.

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04032-y ◽

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.

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

10.21203/rs.3.rs-54612/v3 ◽

2021 ◽

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.

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

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20140135 ◽

2014 ◽

Vol 72 (10) ◽

pp. 782-787 ◽

Cited By ~ 8

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.

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Axial loading during MRI reveals insufficient effect of percutaneous interspinous implants (Aperius™ PerCLID™) on spinal canal area

European Spine Journal ◽

10.1007/s00586-019-06159-y ◽

2019 ◽

Vol 29 (1) ◽

pp. 122-128 ◽

Cited By ~ 1

Author(s):

Hrafnhildur Hjaltadottir ◽

Hanna Hebelka ◽

Caroline Molinder ◽

Helena Brisby ◽

Adad Baranto

Keyword(s):

Spinal Canal ◽

Axial Loading ◽

Adjacent Level ◽

Cross Sectional ◽

Beneficial Effects ◽

Dural Sac ◽

Interspinous Implants ◽

Significant Difference ◽

Interspinous Process Device ◽

Lumbar Spinal

Abstract Purpose To evaluate the effect on the spinal canal at the treated and adjacent level(s), in patients treated for lumbar spinal stenosis (LSS) with percutaneous interspinous process device (IPD) Aperius™ or open decompressive surgery (ODS), using axial loading of the spine during MRI (alMRI). Materials Nineteen LSS patients (mean age 67 years, range 49–78) treated with IPDs in 29 spine levels and 13 LSS patients (mean age 63 years, range 46–76) operated with ODS in 22 spine levels were examined with alMRI pre- and 3 months postoperatively. Radiological effects were evaluated by measuring the dural sac cross-sectional area (DSCSA) and by morphological grading of nerve root affection. Results For the IPD group, no DSCSA increase was observed at the operated level (p = 0.42); however, a decrease was observed in adjacent levels (p = 0.05). No effect was seen regarding morphological grading (operated level: p = 0.71/adjacent level: p = 0.94). For the ODS group, beneficial effects were seen for the operated level, both regarding DSCSA (p < 0.001) and for morphological grading (p < 0.0001). No changes were seen for adjacent levels (DSCSA; p = 0.47/morphological grading: p = 0.95). Postoperatively, a significant difference between the groups existed at the operated level regarding both evaluated parameters (p < 0.003). Conclusions With the spine imaged in an axial loaded position, no significant radiological effects of an IPD could be detected postoperatively at the treated level, while increased DSCSA was displayed for the ODS group. In addition, reduced DSCSA in adjacent levels was detected for the IPD group. Thus, the beneficial effects of IPD implants on the spinal canal must be questioned. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

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Spinal subarachnoid space tapering in patients with syringomyelia

The Neuroradiology Journal ◽

10.1177/1971400919854695 ◽

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.

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Comparative Study of Imaging Parameters between a New Cervical Full Lamina Back Shift Spinal Canal Enlargement Technique and Single Open-door Laminoplasty for Multisegment Cervical Spondylotic Myelopathy

10.21203/rs.3.rs-93191/v1 ◽

2020 ◽

Author(s):

Xiaonan Wang ◽

Yibo Zhao ◽

Xiangdong Lu ◽

Xiaofeng Zhao ◽

Detai Qi ◽

...

Keyword(s):

Internal Fixation ◽

Spinal Canal ◽

Cervical Spondylotic Myelopathy ◽

Sectional Area ◽

Open Door ◽

Mr Images ◽

Titanium Plate ◽

Cross Sectional ◽

Imaging Parameters ◽

Canal Enlargement

Abstract Purpose To provide imaging evidence of the feasibility and clinical efficacy of a new full lamina back shift spinal canal enlargement technique by comparing its imaging parameters to those of single open-door miniature titanium plate internal fixation.Methods A retrospective analysis was conducted on 64 patients with multisegment cervical spondylotic myelopathy caused by cervical stenosis. Of these, 32 underwent the new full lamina back shift spinal canal enlargement technique (observation group), and 32 underwent single open-door miniature titanium plate internal fixation (control group). The CT data of both groups were imported into Mimics 17.0 software to measure the median sagittal diameter and cross-sectional area of the spinal canal. Photoshop CS5 was employed to measure the drift distance of the spinal cord on MR images to perform a comparative study of the imaging parameters from the two groups.Results The T2-weighted MR images in both groups showed continuous recovery of the cerebrospinal fluid signal in the C3–C7 range. The new full lamina back shift spinal canal enlargement technique was significantly superior to single open-door miniature titanium plate internal fixation with respect to the spinal canal cross-sectional area and the median sagittal diameter (P<0.05). No significant difference was detected in the drift distance of the spinal cord between the two groups (P>0.05).Conclusion The new full lamina back shift spinal canal enlargement technique achieved a thorough spinal canal decompression effect on imaging while ensuring a reasonable spinal drift distance and few surgical complications. The clinical curative effect of the new technique was precise.

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