Value of nerve root sedimentation sign in diagnosis and surgical indication of lumbar spinal stenosis.

BACKGROUND: Lumbar spinal stenosis (LSS) is a prevalent and disabling cause of low back and leg pain in elderly people and nerve root sedimentation sign (NRSS) has been demonstrated to have high sensitivity and specificity in diagnosing LSS in selected patients. The purpose of this study was to investigate the diagnosis of LSS and the predictive value of NRSS. METHODS: The clinical and imaging data of 176 patients diagnosed with LSS and 156 patients with non-specific low back pain (LBP) were analyzed retrospectively. Transverse magnetic resonance images (MRI) of the narrowest spinal canal in all patients were acquired and graded by two experienced doctors using the Braz classification, Schizas classification and Chen Jia classification. Receiver operating curve (ROC) was used to compare the diagnostic efficacy of the three classifications. Univariate and multivariate logistic regression models were established to predict the surgical indications of LSS patients. RESULT: The diagnostic efficacy of Schizas classification (AUC:0.943; 95%CI:0.918,0.969) and Chen Jia classification (AUC:0.942; 95%CI:0.918,0.966) was significantly higher than that of Braz classification (AUC:0.853; 95%CI:0.808,0.898). Chen Jia classification had the highest correlation with the degree of dural sac cross-sectional area (DCSA) stenosis. In the multivariate analysis of LSS surgical indications, Chen Jia classification (odds ratio [OR], 2.127; 95%CI:1.596,2.835), DCSA (OR,0.398; 95%CI:0.169,0.802) and intermittent claudication (OR,9.481; 95%CI:3.439,26.142) were associated with surgical indications. CONCLUSION: Among the three types, it is found that Chen Jia classification has better diagnostic efficacy in differentiating LSS from LBP. In addition, Chen Jia classification is simple to be implemented in clinical practice and has high clinical application value. Hence, Chen Jia classification can be used as an effective surgical treatment indicator for LSS patients.

Study on the Correlation between different Levels of Patients with Vertebrobasilar Dolichoectasia and Posterior Circulation Blood Perfusion.

OBJECTIVE: This study investigates the differences and changing trend of posterior circulation blood perfusion between different levels of vertebrobasilar dolichoectasia(VBD) patients. The relationship between the deviation of the basilar artery(BA) in different directions and the location of pontine infarction are also investigated. METHODS: A cohort of 106 patients(74 males and 32 females) who satisfied the diagnostic criteria for VBD were recruited for this study and classified according to the bifurcation height and the deviation position of the BA, as well as the measured blood perfusion value of the pontine, which includes rCBF, rCBV, MTT, and TTP. RESULTS: Out of the 106 patients, 19 cases were classified as Level 1, 74 cases were classified as Level 2, and 13 cases were classified as Level 3. The different levels between the VBD groups were statistically significant (P<0.05, P<0.01), and it was found that as the level increases, rCBF and rCBV gradually decreased, while MTT and TTP gradually increased. The statistic results of different perfusion parameters were also significant, when pairwise comparisons between Level 1 and Level 3, and Level 2 and Level 3 were performed. However, when comparing Level 1 and Level 2, only the TTP showed significant result. Among 106 patients, 22 cases had brainstem infarction, 13 cases had left brainstem infarction, 8 cases had right brainstem infarction, and 1 case had brainstem infarction on both sides. Brainstem infarction generally occurs on the opposite side of the direction of BA deviation(P<0.05). Regardless of the BA was deviated to the left or right, perfusion analysis showed that there was significant difference in blood perfusion on both sides of the pontine when BA is deviated(P<0.05, P<0.01). The rCBF and rCBV on the contralateral side of deviation were lower than those on the same side, and the MTT and TTP were longer than those on the same side. There were 37 cases with vertebral artery dominance(VAD), 16 cases with left VAD, and 21 cases with right VAD. Statistical analysis showed that BA was more likely to deflect to the opposite side of the dominant artery(P<0.05), and compared with non-VAD, there was no significant difference in pontine blood perfusion (p>0.05). CONCLUSION: As VBD level increases, rCBF and rCBV will gradually decreases while MTT and TTP showed sign of increasing. The location of brainstem infarction is opposite to the direction of the BA deviation, and BA is more likely to deviate to the opposite side of the dominant artery.