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

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.

Download Full-text

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

Download Full-text

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.

Download Full-text

Microscopic decompressive laminectomy versus percutaneous endoscopic decompressive laminectomy in patients with lumbar spinal stenosis: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-037096 ◽

2020 ◽

Vol 10 (9) ◽

pp. e037096

Author(s):

Rong Wang ◽

Xiuxia Li ◽

Xiaogang Zhang ◽

Daping Qin ◽

Guodong Yang ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Meta Analysis ◽

The Elderly ◽

Cochrane Library ◽

Lumbar Degenerative Disease ◽

Decompressive Laminectomy ◽

Ethical Approval ◽

Randomised Controlled ◽

Lumbar Spinal

IntroductionLumbar spinal stenosis (LSS) is a common lumbar degenerative disease in the elderly, usually requiring surgery if conservative treatment fails. Microscopic decompressive laminectomy (MDL) and percutaneous endoscopic decompressive laminectomy (PEDL) have been widely used to treat LSS. This study aims to provide a protocol for the evaluation and comparison of the efficacy, safety and applicability between MDL and PEDL.Methods and analysisWe will search for randomised controlled trials (RCTs) comparing MDL and PEDL for treating LSS from inception to December 2019 in the following databases: PubMed, The Cochrane Library, Web of Science, Embase and China Biology Medicine. The quality of included studies will be assessed using the risk of bias tool recommended by the Cochrane Handbook 5.2.0. Subsequently, a meta-analysis will be performed using RevMan 5.3 software.Ethics and disseminationGiven the nature of this study, no ethical approval will be required. The protocol will be disseminated via a peer-reviewed journal.PROSPERO registration numberCRD42020164765.

Download Full-text