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Sedimentation sign did not help predict lumbar stenosis surgical outcomes
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Research showed that the nerve root sedimentation signed was unable to help investigators detect central lumbar spinal stenosis in patients treated with decompression surgery in a pilot study, but it may be a useful techniques when used in non-surgical patients pending results of prospective randomized trials.
“We were not able to conduct an unbiased formal test for interaction to examine whether the sedimentation sign can be used to define a patient group who are more or less likely to benefit from surgery. Even so, our analyses of the prognostic significance of the sign in patients selected to each treatment option were valuable to explore the sedimentation sign’s potential importance for treatment decisions. As such, this study should be regarded as an exploratory pilot study, which has established that the sedimentation sign holds sufficient promise to warrant a larger definitive trial,” Thomas Barz, MD, and colleagues wrote in their study.
The researchers evaluated 118 consecutive patients with a median age of 62 years suspected lumbar spinal stenosis (52% women). Patients were followed up for 24 months, median.
The primary outcomes measures in the study were the changes in Oswestry Disability Index (ODI) and pain VAS pain from baseline to the follow-up examinations, which Barz and colleagues compared in patients with positive and negative sedimentation signs.
They also conducted a separate analysis of the patients treated with decompression and those treated nonsurgically.
In the study, 69 patients underwent surgery. Their average baseline ODI was 54.7%, and the sign was positive in 39 patients and negative in 30 patients, but the ODI and pain improvement was not statistically significant different between those with and without the sign, Barz and colleagues noted in the study. The 49 patients in the nonsurgical group had a mean baseline ODI of 42.4%, and in that group the sign was positive in 18 patients and negative in 31 patients. A positive sign was associated in that group with a lower ODI score and less back pain improvement than when the sign was negative.
“In non-surgically treated patients, a positive sign is associated with more limited improvement. In these cases, surgery might be effective, but this needs investigation in prospective randomized trials,” Barz and colleagues wrote. – by Robert Linnehan
Disclosure: The researchers report no relevant financial disclosures.
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Barz T. Spine J. 2014. DOI: 10.1016/j.spinee.2013.06.105
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