Increased intraoperative epidural pressure in lumbar spinal stenosis patients with a positive nerve root sedimentation sign

Barz, Thomas; Melloh, Markus; Staub, Lukas P.; Lord, Sarah J.; Lange, Jörn; Merk, Harry R. (2014). Increased intraoperative epidural pressure in lumbar spinal stenosis patients with a positive nerve root sedimentation sign. European spine journal, 23(5), pp. 985-990. Springer 10.1007/s00586-013-3071-3

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Purpose The sedimentation sign (SedSign) has been shown to discriminate well between selected patients with and without lumbar spinal stenosis (LSS). The purpose of this study was to compare the pressure values associated with LSS versus non-LSS and discuss whether a positive SedSign may be related to increased epidural pressure at the level of the stenosis. Methods We measured the intraoperative epidural pressure in five patients without LSS and a negative SedSign, and in five patients with LSS and a positive SedSign using a Codman TM catheter in prone position under radioscopy. Results Patients with a negative SedSign had a median epidural pressure of 9 mmHg independent of the measurement location. Breath and pulse-synchronous waves accounted for 1–3 mmHg. In patients with monosegmental LSS and a positive SedSign, the epidural pressure above and below the stenosis was similar (median 8–9 mmHg). At the level of the stenosis the median epidural pressure was 22 mmHg. A breath and pulse-synchronous wave was present cranial to the stenosis, but absent below. These findings were independent of the cross-sectional area of the spinal canal at the level of the stenosis. Conclusions Patients with LSS have an increased epidural pressure at the level of the stenosis and altered pressure wave characteristics below. We argue that the absence of sedimentation of lumbar nerve roots to the dorsal part of the dural sac in supine position may be due to tethering of affected nerve roots at the level of the stenosis.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute for Evaluative Research into Orthopaedic Surgery

UniBE Contributor:

Staub, Lukas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0940-6719

Publisher:

Springer

Language:

English

Submitter:

Ives Gerber

Date Deposited:

16 Jun 2014 11:03

Last Modified:

09 Nov 2015 10:35

Publisher DOI:

10.1007/s00586-013-3071-3

PubMed ID:

24166020

BORIS DOI:

10.7892/boris.49413

URI:

https://boris.unibe.ch/id/eprint/49413

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