Post-surgical functional recovery, lumbar lordosis, and range of motion associated with MR-detectable redundant nerve roots in lumbar spinal stenosis

Chen, Jinshui; Wu, Juying; Wang, Benhai; Xu, Hao; Shen, Lin; Zhang, Huihao

doi:10.1016/j.clineuro.2015.11.016

Cited by 23 publications

(25 citation statements)

References 21 publications

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“…1). In the remaining 40% of patients, redundant nerve roots (RNRs) of the cauda equina are evident on preoperative magnetic resonance images (MRIs) [2][3][4][5]. RNRs were first described by Verbiest [6] in 1954, and they were named 14 years later by Cressman and Pawl [7].…”

Section: Introductionmentioning

confidence: 99%

Redundant nerve roots in lumbar spinal stenosis: inter- and intra-rater reliability of an MRI-based classification

et al. 2019

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Purpose Patients with central lumbar spinal stenosis (LSS) have a longer symptom history, more severe stenosis, and worse postoperative outcomes, when redundant nerve roots (RNRs) are evident in the preoperative MRI. The objective was to test the inter-and intra-rater reliability of an MRI-based classification for RNR. Methods This is a retrospective reliability study. A neuroradiologist, an orthopedic surgeon, a neurosurgeon, and three orthopedic surgeons in-training classified RNR on 126 preoperative MRIs of patients with LSS admitted for microsurgical decompression. On sagittal and axial T2-weighted images, the following four categories were classified: allocation (A) of the key stenotic level, shape (S), extension (E), and direction (D) of the RNR. A second read with cases ordered differently was performed 4 weeks later. Fleiss and Cohen's kappa procedures were used to determine reliability. Results The allocation, shape, extension, and direction (ASED) classification showed moderate to almost perfect inter-rater reliability, with kappa values (95% CI) of 0.86 (0.83, 0.90), 0.62 (0.57, 0.66), 0.56 (0.51, 0.60), and 0.66 (0.63, 0.70) for allocation, shape, extension, and direction, respectively. Intra-rater reliability was almost perfect, with kappa values of 0.90 (0.88, 0.92), 0.86 (0.84, 0.88), and 0.84 (0.81, 0.87) for shape, extension, and direction, respectively. Intra-rater kappa values were similar for junior and senior raters. Kappa values for inter-rater reliability were similar between the first and second reads (p = 0.06) among junior raters and improved among senior raters (p = 0.008). Conclusions The MRI-based classification of RNR showed moderate-to-almost perfect inter-rater and almost perfect intra-rater reliability.

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Section: Introductionmentioning

confidence: 99%

Redundant nerve roots in lumbar spinal stenosis: inter- and intra-rater reliability of an MRI-based classification

et al. 2019

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“…Lumbar spinal stenosis (LSS) is the most common reason for lumbar spine surgery in patients older than 65 years [1]. Around 40% of all LSS patients scheduled for decompression surgery show evidence of RNRs of the cauda equina on their preoperative MRI [2–4].…”

Section: Introductionmentioning

confidence: 99%

“…Reports indicated that LSS patients with preoperative evidence of RNRs (RNR+) have a significantly longer mean duration of neurological symptoms and experience less improvement in their ability to walk after surgery in comparison to patients without RNRs (RNR-) [2, 6, 8, 9].…”

Section: Introductionmentioning

confidence: 99%

Patient demographics and MRI-based measurements predict redundant nerve roots in lumbar spinal stenosis: a retrospective database cohort comparison

Papavero

Marques

Lohmann

et al. 2018

BMC Musculoskelet Disord

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BackgroundUp to 40% of patients diagnosed with lumbar spinal stenosis (LSS) show evidence of redundant nerve roots (RNR) of the cauda equina on their magnetic resonance images (MRI). The etiology of RNR is still unclear. Preoperative evidence of RNR is associated with a worse postsurgical outcome. Consequently, potential predictors of RNR could have a prognostic value. The aim was to test whether patient demographics and MRI-based measurements can predict RNR in LSS patients.MethodsIn a retrospective database-based cohort study the preoperative data of 300 patients, 150 with (RNR+) and 150 without (RNR-) evidence of RNR on their MRI were analyzed. Three independent researchers performed the MRI reads. Potential predictors were age, gender, body height (BH), length of lumbar spine (LLS), segmental length of lumbar spine (SLLS), lumbar spine alignment deviation (LSAD), relative LLS (rLLS), relative SLLS (rSLLS), number of stenotic levels (LSS-level), and grade of LSS severity (LLS-grade, increasing from A to D). Binomial logistic regression models were performed.ResultsRNR+ patients were 2.6 years older (p = 0.01). Weak RNR+ predictors were a two-years age increase (OR 1.06; p = 0.02), 3 cm BH decrease (OR 1.09; p = 0.01) and a 5 mm SLLS decrease (OR 1.34; p < 0.001). Strong RNR+ predictors were a 1% rLLS decrease (OR 2.17; p < 0.001), LSS-level ≥ 2 (OR 2.59; p = 0.001), LLS-grade C (OR 5.86; p = 0.02) and LLS-grade D (OR 18.4; p < 0.001). The mean rSLLS of RNR+ patients was 0.6% shorter (p < 0.001; 95% C.I. 0.4 to 0.8) indicating a disproportionate shorter lumbar spine.ConclusionsWe identified LSS severity grade and LSS levels as the strongest predictors of RNR. In addition to previous studies, we conclude that a shortened lumbar spine by degeneration is involved in the development of RNR.

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“…Furthermore, the severity of lumbar spinal canal stenosis was demonstrated as a risk factor for RNRs . The pathogenesis of RNRs is still unclear, and it has been suggested that RNRs are associated with damaged nerve roots and impaired nerve–blood barrier resulting from spinal canal constriction . Further studies on the relationship between electrophysiological features and RNRs on MRI can help understand the clinical implication of RNRs in DSD.…”

Section: Discussionmentioning

confidence: 99%

Electrodiagnostic characteristics of upper lumbar stenosis: Discrepancy between neurological and structural levels

2020

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Background: Radiculopathies caused by spinal stenosis in the upper lumbar spinal canal (L1/2, L2/3, L3/4) have not been comprehensively investigated. Methods: This retrospective study reviewed 14 patients from a tertiary hospital outpatient clinic. The inclusion criteria were upper lumbar stenosis seen on MRI and radiculopathies with active denervation confirmed on electromyography. Patients with any other conditions that could explain the clinical or electrophysiological manifestations were excluded.Results: Neurogenic findings were predominantly observed in L5 or S1 myotomes on electromyography. Abnormal spontaneous activity was observed in distal muscles in all patients and in proximal muscles in eight patients. Axonal involvement was bilateral in 10 patients and unilaterally in 4 patients. MRI showed redundant nerve roots in 13 patients with chronic reinnervation on electromyography.Conclusions: Upper lumbar spinal stenosis usually causes L5 or S1 radiculopathies with diverse patterns. This discrepancy may cause diagnostic confusion. K E Y W O R D S electromyography, lumbosacral, magnetic resonance image, nerve root compressions, radiculopathy, upper lumbar spinal stenosis

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Post-surgical functional recovery, lumbar lordosis, and range of motion associated with MR-detectable redundant nerve roots in lumbar spinal stenosis

Cited by 23 publications

References 21 publications

Redundant nerve roots in lumbar spinal stenosis: inter- and intra-rater reliability of an MRI-based classification

Redundant nerve roots in lumbar spinal stenosis: inter- and intra-rater reliability of an MRI-based classification

Patient demographics and MRI-based measurements predict redundant nerve roots in lumbar spinal stenosis: a retrospective database cohort comparison

Electrodiagnostic characteristics of upper lumbar stenosis: Discrepancy between neurological and structural levels

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