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Diagnostic performance of the nerve root sedimentation sign in lumbar spinal stenosis: a systematic review and meta-analysis

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Abstract

Purpose

This meta-analysis intends to use all available evidence to clarify the diagnostic performance of the nerve root sedimentation sign (NRSS).

Methods

The PubMed, EMBASE, the Cochrane Library database, China knowledge Infrastructure Project (CNKI), and Wanfang Database were searched up to January 2019 for relevant original studies. Data were extracted to calculate the pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative likelihood ratios (PLR and NLR), and areas under summary receiver operating characteristic curve (SROC) for analysis. The clinical applicability was evaluated with a Fagan’s plot and likelihood ratio dot diagram. Deek’s funnel plot was used to assess publication bias.

Results

A total of 14 studies including 1333 positive cases and 2658 negative controls were available for the meta-analysis. The pooled sensitivity and specificity of the NRSS for the diagnosis of LSS was 0.84 (95% CI 0.75, 0.91) and 0.95 (95% CI 0.81, 0.99), respectively. The PLR was 18.6 (95% CI 4.0, 86.8), the NLR was 0.17 (95% CI 0.10, 0.28), and the DOR was 112 (95% CI 17,741). The SROC value was 0.93 (95% CI 0.91, 0.95). The Fagan’s plot showed that the pre-test probability was 50% and the post-test probability was 95%. The likelihood ratio dot graph showed that the combined effect of the diagnosis fell on the right upper quadrant. Deek’s funnel found no publication bias.

Conclusion

NRSS has high diagnostic sensitivity, specificity, and efficacy, and good clinical application value for the diagnosis of LSS. It can be recommended as an auxiliary tool for diagnosis and screening in clinical practice.

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Abbreviations

MRI:

Magnetic resonance imaging

SROC:

Summary receiver operating characteristic curves

AUC:

Area under the curve

QUADAS:

Quality Assessment Diagnostic Accuracy Studies

CI:

Confidence interval

LR:

Likelihood ratio

SEN:

Weighted sensitivity

SPE:

Weighted specificity

TP:

True positive

TN:

True negative

FP:

False positive

FN:

False negative

DOR:

Diagnostic odds ratio

DSCA:

Dural sac cross-sectional area

AP:

Anteroposterior spinal canal diameter

NLBP:

Nonspecific low back pain

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Acknowledgements

We sincerely thank Professor Zhang yuan-yu (Affiliated Baoan Hospital of Shenzhen, Southern Medical University) for his invaluable advice, constant encouragement, and precise modification of the manuscript. We would also like to express our appreciation to all the members who participated in the study. In addition, we also thank nativeee.com for its linguistic assistance during the preparation of this manuscript.

Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Spinal Surgery, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, No.118 , Longjing Two Road , Xinan Street, Shenzhen, 518101, People’s Republic of China

    Guangye Wang, Zhan Peng, Jin Li, Zukun Song & Pu Wang

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  1. Guangye Wang
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  2. Zhan Peng
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  3. Jin Li
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Correspondence to Zhan Peng.

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The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of this study.

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Institutional Review Board approval was not required because we only performed data analysis based on published studies.

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Written informed consent was not required for this study because it is a meta-analysis based on studies that have already been published

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Wang, G., Peng, Z., Li, J. et al. Diagnostic performance of the nerve root sedimentation sign in lumbar spinal stenosis: a systematic review and meta-analysis. Neuroradiology 61, 1111–1121 (2019). https://doi.org/10.1007/s00234-019-02248-3

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  • DOI: https://doi.org/10.1007/s00234-019-02248-3

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