Redundant Nerve Roots of the Cauda Equina: Clinical Aspects and Consideration of Pathogenesis

Suzuki, Kazuhiro; Ishida, Yoshihiro; Ohmori, Kazuo; Sakai, Hisashi; Hashizume, Yoshio

doi:10.1227/00006123-198904000-00006

Cited by 48 publications

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“…The literature describes this entity in association with degenerative spinal canal stenosis ( Figure 1). It is believed that the acquired elongation of the nerve roots is due to a chronic compression force at the level of the lumbar spinal stenosis (LSS) 9 . This condition is not a new or separate disease but may be part of the natural evolution of lumbar canal stenosis.…”

Section: Introductionmentioning

confidence: 99%

“…The recognition of RNRCE in diagnostic imaging is especially important for avoiding the misdiagnosis of other diseases, such as arteriovenous malformations 9 . The reported prevalence of RNRCE varies, with some researchers determining prevalence values of 33.8% to 42% in patients with spinal canal stenosis 9,10 .…”

Section: Introductionmentioning

confidence: 99%

“…The reported prevalence of RNRCE varies, with some researchers determining prevalence values of 33.8% to 42% in patients with spinal canal stenosis 9,10 .…”

Section: Introductionmentioning

confidence: 99%

“…It is believed that the acquired elongation of the nerve roots is due to a chronic compression force at the level of the lumbar spinal stenosis (LSS) 9 . This condition is not a new or separate disease but may be part of the natural evolution of lumbar canal stenosis.The recognition of RNRCE in diagnostic imaging is especially important for avoiding the misdiagnosis of other diseases, such as arteriovenous malformations 9 . The reported prevalence of RNRCE varies, with some researchers determining prevalence values of 33.8% to 42% in patients with spinal canal stenosis 9,10 .…”

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confidence: 99%

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Cauda equina redundant nerve roots are associated to the degree of spinal stenosis and to spondylolisthesis

Savarese

Ferreira-Neto²,

Herrero

et al. 2014

Arq. Neuro-Psiquiatr.

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To evaluate the association of redundant nerve roots of cauda equina (RNRCE) with the degree of lumbar spinal stenosis (LSS) and with spondylolisthesis. Method: After Institutional Board approval, 171 consecutive patients were retrospectively enrolled, 105 LSS patients and 66 patients without stenosis. The dural sac cross-sectional area (CSA) was measured on T2w axial MRI at the level of L2-3, L3-4 and L4-5 intervertebral discs. Two blinded radiologists classified cases as exhibiting or not RNRCE in MRI. Intra-and inter-observer reproducibility was assessed. Results: RNRCE were associated with LSS. RRNCE was more frequent when maximum stenosis,55 mm 2 . Substantial intra-observer agreement and moderate inter-observer agreement were obtained in the classification of RNRCE. Spondylolisthesis was identified in 27 patients and represented increased risk for RRNCE. Conclusion: LSS is a risk factor for RNRCE, especially for dural sac CSA,55 mm 2 . LSS and spondylolisthesis are independent risk factors for RNRCE.Keywords: magnetic resonance imaging, spinal nerve roots, cauda equina, spinal stenosis, spondylolisthesis. RESUMOAvaliar associação entre raízes nervosas redundantes da cauda eqüina (RNRCE) com grau de estenose do canal lombar (ECL) e espondilolistese. Método: Após aprovação do Comitê de Ética, 171 pacientes foram selecionados retrospectivamente, 105 com ECL e 66 sem estenose. Foram realizadas mensurações da área seccional do saco dural em imagens axiais de RM ponderadas em T2 em L2/L3, L3/L4 e L4/ L5. Presença ou não de RRNCE foi classificada de forma independente por dois radiologistas, às cegas. Concordância intra e inter-observador foi analisada. Resultados: RNRCE foi associada à ECL e foi mais freqüente quando a máxima estenose encontrada foi ,55mm 2. Houve grande concordância intra-observador e moderada inter-observador na classificação das RRNCE. Espondilolistese foi identificada em 27 pacientes e representou maior risco para desenvolvimento de RNRCE. Conclusão: ECL é fator de risco para RNRCE, especialmente com áreas seccionais ,55mm 2. ECL e espondilolistese representam fatores de risco independentes para desenvolvimento de RNRCE.Palavras-chave: ressonância magnética, raizes nervosas, cauda equina, estenose espinhal, espondilolistese.Redundant nerve roots of the cauda equina (RNRCE) are characterised in magnetic resonance images (MRIs) of the lumbosacral spinal cord by the presence of elongated and tortuous nerve roots with a serpiginous or coiled appearance and near an area of spinal canal stenosis 1,2,3,4,5,6,7,8 . The literature describes this entity in association with degenerative spinal canal stenosis (Figure 1). It is believed that the acquired elongation of the nerve roots is due to a chronic compression force at the level of the lumbar spinal stenosis (LSS) 9 . This condition is not a new or separate disease but may be part of the natural evolution of lumbar canal stenosis.The recognition of RNRCE in diagnostic imaging is especially important for avoiding the misdiagnosis of other dis...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The reported prevalence of RNRCE varies, with some researchers determining prevalence values of 33.8% to 42% in patients with spinal canal stenosis 9,10 .…”

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Cauda equina redundant nerve roots are associated to the degree of spinal stenosis and to spondylolisthesis

Savarese

Ferreira-Neto²,

Herrero

et al. 2014

Arq. Neuro-Psiquiatr.

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“…In LCS patients, myelography and MRI often reveal a redundant nerve root (RNR). Suzuki et al 42 pathologically investigated the cauda equina at autopsy and reported that the cause of nerve root redundancy was Wallerian degeneration. Takeno et al 43 administered PGE 1 on a daily basis for 2 weeks to LCS patients with NIC and reported that MRI showed RNR in 56% of the patients in whom NIC did not resolve, while enhanced MRI showed intraradicular edema in 84% of them.…”

Section: Discussionmentioning

confidence: 99%

Blood flow analysis of compressed nerve root after intravenous injection of lipo‐prostaglandin E₁

Kobayashi¹,

Baba²,

Takeno³

et al. 2009

Journal Orthopaedic Research

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Prostaglandin E 1 (PGE 1 ) is a potent vasodilator as well as an inhibitor of platelet aggregation and has therefore attracted interest as a therapeutic drug for lumbar canal stenosis. However, investigations in the clinical setting have shown that PGE 1 is effective in some patients but not in others, although the reason for this is unclear. The aim of the present study was to measure changes in intraradicular blood flow after intravenous injection of lipo-PGE 1 (0.15 mg/kg) using a laser Doppler flow meter in control model and nerve root compression model. Then, the nerve root in which blood flow was measured was removed and examined histologically. Intravenous injection of lipo-PGE 1 also resulted in marked increase of blood flow in the uncompressed nerve roots of the control group, but caused minimal enhancement of blood flow at the sites of nerve root compression exhibiting Wallerian degeneration. It is concluded that lipo-PGE 1 has less effect on markedly degenerated nerve roots than it does on those that are normal. ß

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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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Redundant Nerve Roots of the Cauda Equina: Clinical Aspects and Consideration of Pathogenesis

Cited by 48 publications

References 0 publications

Cauda equina redundant nerve roots are associated to the degree of spinal stenosis and to spondylolisthesis

Cauda equina redundant nerve roots are associated to the degree of spinal stenosis and to spondylolisthesis

Blood flow analysis of compressed nerve root after intravenous injection of lipo‐prostaglandin E₁

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

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Redundant Nerve Roots of the Cauda Equina: Clinical Aspects and Consideration of Pathogenesis

Cited by 48 publications

References 0 publications

Cauda equina redundant nerve roots are associated to the degree of spinal stenosis and to spondylolisthesis

Cauda equina redundant nerve roots are associated to the degree of spinal stenosis and to spondylolisthesis

Blood flow analysis of compressed nerve root after intravenous injection of lipo‐prostaglandin E1

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

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Blood flow analysis of compressed nerve root after intravenous injection of lipo‐prostaglandin E₁