Clinical Significance of Postoperative Changes in Redundant Nerve Roots After Decompressive Laminectomy for Lumbar Spinal Canal Stenosis

Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Tanaka, Hidekazu; Ito, Yutaka; Hirano, Masashi; Kawabata, Shinji; Kuroiwa, Toshihiko

doi:10.1016/j.wneu.2013.09.024

Cited by 20 publications

(41 citation statements)

References 16 publications

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“…Although in conformity with a previous report [11] the majority of RNRs in the present work were loop shaped (72 %), it is not known with certainty that whether serpentine-shaped RNRs actually occur less frequently or they just go unnoticed because of MRI imperfection. Nevertheless, it should be noted that even if MRI is not as accurate as lumbar myelogram in detecting RNRs [14], it is noninvasive and more importantly, it demonstrates more advanced RNRs, which are thought to represent important clinical findings [5].…”

Section: Discussionsupporting

confidence: 88%

“…The other factor is thought to be the morphology of RNRs. It has been shown that while MRI is very sensitive in detecting loop-shaped RNRs, its accuracy decreases dramatically in visualizing serpentine-shaped RNRs [11].…”

Section: Discussionmentioning

confidence: 99%

“…Although not yet a consensus, it has been suggested that the evidence of RNRs of the cauda equina is along with irreversible abnormalities of the nerve roots and poor prognosis in patients with lumbar spinal canal stenosis [4,5,10,11,15,22]. On the basis of these reports, some investigators have proposed that the presence of RNRs in patients with lumbar spinal canal stenosis and borderline symptoms or trivial imaging findings might assist in decision-making for invasive interventions [7,23].…”

Section: Discussionmentioning

confidence: 99%

“…The eFilm Workstation v.2.1.2 (Merge Healthcare, Milwaukee, WI, USA) was used for measurements, including the anteroposterior (AP) diameter of the spinal canal at the narrowest level of the stenosis (degree of stenosis) at mid sagittal section; the length of the RNRs relative to the height of the upper vertebral body of the level of the stenosis at mid sagittal section following a method described by Min et al [8][9][10]; the morphologic appearance of RNRs (loop shaped versus serpentine shaped) [11]; and the presence or absence of intracanal protuberances in the site of stenosis with their morphology (with soft or sharp margin, Fig. 2) on mid sagittal MR images.…”

Section: Methodsmentioning

confidence: 99%

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Redundant nerve roots of the cauda equina in lumbar spinal canal stenosis, an MR study on 500 cases

et al. 2015

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Redundant nerve roots of the cauda equina in lumbar spinal canal stenosis, an MR study on 500 cases

et al. 2015

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“…Previous reports describe possible risk factors for poor clinical outcome after lumbar decompression surgery as follows: severe constriction of the dural tube, preoperative periods [9], multiple segments involved, larger sagittal rotation [1011], and residual redundant nerve roots [12]. Itoi et al [3] first described a case-series in which several patients with kissing spine showed postoperative recurrence of sciatica.…”

Section: Discussionmentioning

confidence: 99%

Baastrup's Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures

et al. 2016

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Study DesignRetrospective case-control study.PurposeTo determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach.Overview of LiteratureKissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine.MethodsThe present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica.ResultsStepwise logistic regression revealed kissing spine (p=0.024; odds ratio, 3.80) and foraminal stenosis (p<0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis.ConclusionsWhen a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure.

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Redundant nerve roots on magnetic resonance imaging can predict ongoing denervation in patients with lumbar spinal stenosis

Park,

Hong,

Chung

et al. 2024

Muscle and Nerve

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Introduction/AimsRedundant nerve roots (RNRs) are abnormally elongated and tortuous nerve roots that develop secondary to degenerative spinal stenosis. RNRs have been associated with poorer clinical outcomes after decompression surgery; however, studies on their clinical characteristics are limited. This study aimed to investigate the association between RNRs and denervation potentials, that is, abnormal spontaneous activity (ASA), on electromyography.MethodsWe retrospectively reviewed data of patients who underwent an electrodiagnostic study of the lower extremities between January 2020 and March 2023. Of these, patients with lumbar central spinal stenosis, as seen on magnetic resonance imaging, were included. We analyzed clinical and imaging data, including presence of ASA, and compared them according to the presence of RNRs. Multivariable logistic regression analysis was employed to identify factors associated with development of ASA.ResultsAmong the 2003 patients screened, 193 were included in the study. RNRs were associated with advanced age (p < .001), longer symptom duration (p = .009), smaller cross‐sectional area of the dural sac at the stenotic level (p < .001), and higher frequency of ASA (p < .001). Higher probability of ASA was correlated with greater RNR severity (p < .001). In the multivariable logistic regression analysis, ASA occurrence was associated with smaller cross‐sectional area, multiple stenotic sites, and severe‐grade RNRs.DiscussionThe presence of RNRs, particularly severe‐grade RNRs, was identified as a significant risk factor for the development of ASA on electromyography. This finding may aid physicians in estimating the prognosis of patients with central spinal stenosis.

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Clinical Significance of Postoperative Changes in Redundant Nerve Roots After Decompressive Laminectomy for Lumbar Spinal Canal Stenosis

Cited by 20 publications

References 16 publications

Redundant nerve roots of the cauda equina in lumbar spinal canal stenosis, an MR study on 500 cases

Redundant nerve roots of the cauda equina in lumbar spinal canal stenosis, an MR study on 500 cases

Baastrup's Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures

Redundant nerve roots on magnetic resonance imaging can predict ongoing denervation in patients with lumbar spinal stenosis

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