European Spine Journal

, Volume 25, Issue 11, pp 3770–3770 | Cite as

Authors’ reply to the Letter to the Editor of M. Melloh et al. concerning “Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis” (by PA Laudato et al. (2015) Eur Spine J; 24(10):2264–2268)

  • Constantin SchizasEmail author
  • P. A. Laudato
Letter to the Editor


Personalise Medicine Oswestry Disability Index Spinal Stenosis Lumbar Spinal Stenosis Sedimentation Sign 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

We thank the authors for their thoughtful remarks on our paper [1]. It is true that we did not report, in that particular study, our surgical results. In our previous publication on the morphological grade (which included some of the surgical patients recorded in our latest study), we did report on clinical results and did not observe a relation between degree of stenosis and clinical result measured using the Oswestry Disability Index (ODI) [2]. Nevertheless, average ODI improved from 49 to 29 % after surgery in the surgical group. Admittedly, ODI is not disease-specific, and this might be one of the reasons behind the observed lack of relation. Although a binary tool would be attractive in decision-making, clearly, this would be difficult in clinical practice. For instance, a patient with typical symptoms of lumbar spinal stenosis (LSS) and extreme stenosis on MRI (i.e., a dural sac cross-sectional area <75 mm and a morphological stenosis of grade D) could be denied surgery solely because the sedimentation sign (SedSign) is negative. Yet in our surgical subgroup, nearly a quarter of such patients had a negative SedSign [1]. It would be interesting, indeed, to see if any unsatisfactory results were observed in this subgroup of patients, and this could be the topic of a further study. It is quite likely that not a single diagnostic test will allow deciding who might be a good surgical candidate. Personalised medicine is becoming increasingly popular, and it might be that the same surgical formula will not be applicable to all patients with similar symptoms and clinical signs. Surgical outcome in spine surgery depends on a variety of factors, with psychosocial parameters playing, undoubtedly, an important role [3]. It could be that such parameters will ultimately influence our decision-making more than clinical tests.


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Conflict of interest



  1. 1.
    Laudato PA, Kulik G, Schizas C (2015) Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis. Eur Spine J 24(10):2264–2268CrossRefPubMedGoogle Scholar
  2. 2.
    Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G (2010) Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine 35(21):1919–1924CrossRefPubMedGoogle Scholar
  3. 3.
    Sinikallio S, Aalto T, Koivumaa-Honkanen H, Airaksinen O, Herno A, Kröger H, Viinamäki H (2009) Life dissatisfaction is associated with a poorer surgery outcome and depression among lumbar spinal stenosis patients: a 2-year prospective study. Eur Spine J 18(8):1187–1193CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Neuro-Orthopaedic Spine Unit, Hirslanden Group of Private HospitalsClinique CecilLausanneSwitzerland
  2. 2.Spine Unit, Centre Hospitalier Universitaire VaudoisUniversity of LausanneLausanneSwitzerland

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