The prevalence of redundant nerve roots in patients with lumbar spinal stenosis is body position dependent: a retrospective observational study with repeated measures design in an upright MRI scanner

Abstract Background: To analyze the relational factors influencing the formation of cauda equina redundant nerve roots (RNRs) of the lumbar spinal stenosis.Methods: A retrospective study of 116 patients with lumbar spinal stenosis were treated in our department from January 2016 to June 2019. Magnetic resonance imaging (MRI) was performed to observe the shape and morphology of the redundant nerve roots of the cauda equina.We divided patient into (RNRs) group and non-RNRs( NRNRs) group based on the presence or absence of RNRs on sagittal T2-weighted MR. We analyzed the demographic characteristics, preoperative back pain visual analogue scale (VAS) scores ,preoperative leg pain VAS scores, and preoperative Oswestry disability index(ODI) scores, and also analyzed the rate of spondylolisthesis and ligamentum flavum hypertrophy. Simultaneously,the inter-vertebral height, intervertebral foramen height, inter-vertebral height +vertebral height, median sagittal diameter at the inter-vertebral space level(DIW-MSD),median sagittal diameter at the pedicel level(DV-MSD),ROM of the stenotic segment, were statistically analyzed for clinical and radiological significance.Results : Of a total 116 total patients,there were no statistically significant differences in either gender [RNRs group (n = 42, 18/24 female) and NRNR group (n = 74, 38/36 female)], age, BMI index, preoperative back pain VAS score , preoperative leg pain VAS score and preoperative ODI score(p> 0.05);however, there were statistically significant differences regard to the duration of symptoms and the rate of spondylolisthesis and ligamentum flavum hypertrophy (p<0.05);the inter-vertebral height,Intervertebral foramen height, inter-vertebral height+vertebral height, DIW-MSD ,ROM of the stenotic segment were also significantly different between the group (p<0.05).Conclusions:The inter-vertebral height, inter-vertebral foramen height, inter-vertebral height + vertebral height, DIW-MSD and ROM of the stenotic segment were the crucial factors related to RNRs in lumbar spinal stenosis.

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Redundant Nerve Roots in Patients with Degenerative Lumbar Spinal Stenosis

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.1991.26.4.1226 ◽

1991 ◽

Vol 26 (4) ◽

pp. 1226

Author(s):

Won Sik Choy ◽

Sung Soo Joh ◽

Chang Hyun Baik ◽

Hyun Jin Jang

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Nerve Roots ◽

Degenerative Lumbar Spinal Stenosis ◽

Lumbar Spinal

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A Meta-Analysis on the Clinical Significance of Redundant Nerve Roots in Symptomatic Lumbar Spinal Stenosis

World Neurosurgery ◽

10.1016/j.wneu.2017.05.103 ◽

2017 ◽

Vol 105 ◽

pp. 95-101 ◽

Cited By ~ 4

Author(s):

Lin Cong ◽

Yue Zhu ◽

Qi Yan ◽

Guanjun Tu

Keyword(s):

Clinical Significance ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Meta Analysis ◽

Nerve Roots ◽

Lumbar Spinal

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

Neuroradiology ◽

10.1007/s00234-019-02337-3 ◽

2019 ◽

Vol 62 (2) ◽

pp. 223-230 ◽

Cited By ~ 2

Author(s):

Luca Papavero ◽

Carlos J. Marques ◽

Jens Lohmann ◽

Thies Fitting ◽

Kathrin Schawjinski ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Nerve Roots ◽

Severe Stenosis ◽

Rater Reliability ◽

Microsurgical Decompression ◽

Orthopedic Surgeons ◽

Symptom History ◽

Lumbar Spinal

Abstract 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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