神经根沉降征在腰椎管狭窄症中的研究进展

Research progress on nerve root sedimentation sign of lumbar spinal stenosis

目的总结近年神经根沉降征在腰椎管狭窄症中的研究进展。方法查阅近年来国内外相关文献,对神经根沉降征的定义、分型及发生机制,及其在腰椎管狭窄症诊疗中的意义进行归纳总结。结果神经根沉降征是近年来提出的一种腰椎MRI图像中的现象,其发生机制主要为硬膜囊外压力增高。目前对该征象有两种分型方法,研究常用分型方法为二分法,即分为阳性和阴性。鉴别诊断重度腰椎管狭窄症患者和轻度的非特异性下腰痛患者时,神经根沉降征具有较高的敏感性和特异性。研究表明神经根沉降征与手术节段有一定相关性,与手术疗效的相关性存在较大争议。另外,神经根沉降征可用于术后疗效评价,腰椎管狭窄症患者手术后相应节段神经根沉降征由阳性转为阴性,如新出现阳性神经根沉降征则提示出现新的狭窄。结论神经根沉降征临床可以用作腰椎管狭窄症的辅助诊断指标,对治疗方案的选择具有一定指导意义,并能用于腰椎管狭窄症术后疗效的评价。

Objective To summarize the research progress on the nerve root sedimentation sign of lumbar spinal stenosis. Methods The recent domestic and foreign literature in recent years was reviewed. The definition,classification, and mechanism of nerve root sedimentation sign and the relation of nerve root sedimentation sign to diagnosis and treatment of lumbar spinal stenosis were summarized. Results Nerve root sedimentation sign is a phenomena which is found in MRI images of lumbar spine. Its mechanism is mainly increased intraoperative epidural pressure. There are two types of classification and the classification in which nerve root sedimentation sign is classified into "positive" and "negative" is widely applied. It has high sensitivity and specificity in differential diagnosis patients with severe lumbar spinal stenosis and patients with nonspecific low back pain. As for treatment, the nerve root sedimentation sign is related to the surgical disc levels. However, it’s not sure if the nerve root sedimentation sign is related to surgical outcome. In addition, a positive sedimentation sign turns negative after sufficient surgical decompression and a new positive sedimentation sign after sufficient decompression surgery could be used as an indicator of new stenosis in previously operated patients. Conclusion For lumbar spinal stenosis, the nerve root sedimentation sign can be applied as an auxiliary diagnostic indicator, as a guidance for deciding the operated disc levels,and as a postoperative indicator for evaluating the effectiveness.