Nerve Root Sedimentation Sign for the Diagnosis of Lumbar Spinal Stenosis
Notice bibliographique
Résumé
In Brief Study Design. Retrospective review of magnetic resonance images. Objective. Examine the diagnostic accuracy, discriminative ability, and reliability of the sedimentation sign in a sample of patients with clinically diagnosed lumbar spinal stenosis (LSS), low back pain (LBP), and vascular claudication, and in asymptomatic controls. Summary of Background Data. The nerve root sedimentation sign (SedSign) was recently described as a new diagnostic test for LSS; however, the degree to which this sign is sensitive and specific in diagnosis of LSS is unknown. Methods. All LSS images were obtained from subjects who had clinically diagnosed LSS confirmed on imaging by a spine specialist. The other images were obtained from people with LBP but no LSS, people with severe vascular claudication, and asymptomatic participants. Three blinded raters independently assessed the images. A positive sign was defined as the absence of nerve root sedimentation at the level above or below the level of maximum stenosis. Results. Images from 148 subjects were reviewed (67 LSS, 31 LBP, 4 vascular, and 46 asymptomatic). Intrarater reliability for the sign ranged from κ= 0.87 to 0.97 and inter-rater reliability from 0.62 to 0.69. Sensitivity ranged from 42% to 66%, and specificity ranged from 49% to 78%. Sensitivity improved to a range of 60% to 96% when images with only a smallest cross-sectional area of the dural sac less than 80 mm2 were included. The sign was able to differentiate (P = 0.004) between LSS and asymptomatic controls but not between LSS and LBP or between LSS and vascular claudication. Conclusion. The SedSign was shown to have high intrarater reliability and acceptable inter-rater reliability. The Sign appears most sensitive in defining severe LSS cases, yet may not aid in the differential diagnosis of LSS from LBP or vascular claudication, or add any specific diagnostic information beyond the traditional history, physical examination, and imaging studies that are standard in LSS diagnosis. Level of Evidence: 4 The sedimentation sign was shown to have high intrarater reliability and appears most sensitive in defining severe lumbar spinal stenosis (LSS) cases. Yet, this sign may not aid in the differential diagnosis of LSS from low back pain or vascular claudication or add any specific diagnostic information beyond the history, physical examination, and imaging studies that are standard in LSS diagnosis.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».