Clinical significance and risk factors of redundant nerve root in patients with lumbar spinal stenosis / 中国骨伤

OBJECTIVE@#To investigate the clinical significance and screen the risk factors of redundant nerve roots(RNRs) in patients with lumbar spinal stenosis.@*METHODS@#The clinical data of 196 patients with lumbar spinal stenosis in the department of Spinal Surgery, Yijishan Hospital, Wannan Medical College from April 1, 2015 to November 30, 2020 were retrospectively analyzed. All patients were divided into RNRs positive group and RNRs negative group according to the presence of RNRs. The differences in general clinical data, imaging parameters, visual analogue scale(VAS), Oswestry disability index(ODI), and other indicators between the two groups were compared. The risk factors which are highly correlated with RNRs were screened by binary Logistic regression analysis.@*RESULTS@#There were 59 cases in the RNRs positive group, with an occurrence rate of 29.95% (59/137), and 137 cases in the RNRs negative group. The incidence rate of RNRs in 196 patients with lumbar spinal stenosis was 30.10% (59/196). VAS and ODI scores of patients in the two groups were statistically significant (P<0.05), and clinical symptoms of patients in the RNRs positive group were more severe than those in the RNRs negative group. There were significant differences in age, number of stenosis segments, average area of lumbar dural sac, area of the narrowest segment and the narrowest segment(P<0.05). Binary logistic regression analysis showed that the number of stenosis segments, the average median sagittal diameter of spinal canal, and the average area of dural sac in lumbar intervertebral space were correlated with the generation of RNRs (P<0.05). The regression coefficient of the number of stenosis segments was -1.115, the regression coefficient of the median sagittal diameter of the spinal canal was -1.707, and the regression coefficient of the mean dural sac area of the lumbar intervertebral space was 7.556.@*CONCLUSION@#The clinical symptoms of patients with lumbar spinal stenosis accompanied by RNRs are more severe than those without them. The number of narrow segments, median sagittal diameter of the spinal canal, and the area of the lumbar intervertebral dural sac are the high-risk factors for RNRs, with the area of the lumbar intervertebral dural sac has the highest correlation.

The relationship between lumbar disc degeneration of lumbar spinal stenosis and the dural sac cross-sec-tional area by MRI measurement / 实用医学杂志

Objective To explore the relationship between lumbar disc degeneration (LDD) of lumbar spinal stenosis(LSS)and the dural sac cross-sectional area(DSCA)by MRI measurement. Methods 91 patients with central degenerative LSS were randomly selected and 91 age-and sex-matched people without LSS were select-ed as a control group. LDD was classified into five grades by MRI detection according to the method proposed by Pfirrmann and DSCA were measured. Results LDD was not associated with age in LSS. The proportion of severe degenerated disc in lower lumbar levels were higher than that of L2/3 in the two groups;DSCA in severe degenerat-ed disc group was significantly smaller than that in light degenerated group only in L2/3 and L3/4 in LSS. There were no statistical differences in every lumbar level in the control group. Conclusions LDD in L4/5 and L5/S1 of LSS is more severe than that of the normal people. DSCA and LDD are positively correlated in L2/3 and L3/4,but not in L4/5 and L5/S1 for LSS.

Morphometric Analysis of Distances between Sacral Hiatus and Conus Medullaris Using Magnetic Resonance Image in Korean Adult / 체질인류학회지

The purpose of this study was to provide basic biometric data on Korean adults through magnetic resonance imaging (MRI)-based measurements of the distances between the apex of sacral hiatus (SH) and the termination of dural sac (DS), and between SH and conus medullaris (CM) because they are critical to the performance of epidural neuroplasty. A total of 200 patients (88 males and 112 females) with back pain, who had no spine fracture, significant spinal deformity, and spondyloisthesis were selected for this study. The subjects were of mean age 54.3 (20~84) years and mean height 161.3 cm (135~187). T2-weighted MRI images were used for correlation analysis to evaluate the relationships between the distances, and variables such as sex and height. In all patients, the mean distance between SH and DS was 62.8±9.4 mm and the mean distance between SH and CM was 232.2±21.8 mm. The minimum distance and the maximum distance between SH and DS were 34.8 mm and 93.9 mm respectively, and the minimum distance and the maximum distance between SH and CM were 155.0 mm and 284.0 mm respectively. In female patients, both the distances between the SH and DS, and between SH and CM were shorter when compared to those of the male patients (p<0.05). Both the distances between SH and DS and between SH and CM showed a significant correlation with height (p<0.01). The results of this study will provide a useful biometric data on the distances between SH and DS and between SH and CM in Korean in ensuring clinical safety and in the development of more effective catheterization techniques for epidural neuroplasty in Korean.

Efficacy of Percutaneous Epidural Neuroplasty Does Not Correlate with Dural Sac Cross-Sectional Area in Single Level Disc Disease

PURPOSE: Percutaneous epidural neuroplasty (PEN) is a minimally invasive treatment. The efficacy of PEN has been relatively well investigated; however, the relationship between the clinical effectiveness of PEN and the severity of spinal canal stenosis by disc material has not yet been established. The purpose of this study was to compare clinical outcomes of PEN according to the dural sac cross-sectional area in single level disc disease. MATERIALS AND METHODS: This study included 363 patients with back pain from single level disc disease with and without radiculopathy. Patients were categorized into groups according to spinal canal compromise by disc material: Category 1, less or more than 50%; and Category 2, three subgroups with lesser than a third, between a third and two thirds, and more than two thirds. Clinical outcomes were assessed according to the Visual Analog Scale (VAS) score for back pain and leg pain and Odom's criteria at 1, 3, 6, 12, and 24 months after treatment. RESULTS: The demographic data showed no difference between groups according to spinal canal compromise by disc material except age (older age correlated with more spinal canal compromise). The dural sac cross-sectional area did not correlate with the VAS scores for back and leg pain after PEN in single level disc disease in Groups 1 and 2. Odom's criteria after PEN were also not different according to dural sac cross-sectional area by disc material. CONCLUSION: PEN is an effective procedure in treating single level lumbar disc herniation without affecting dural sac cross-sectional area.

Does spinal stenosis correlate with MRI findings and pain, psychologic factor and quality of life? / 대한마취과학회지

BACKGROUND: To investigate and analyze MRI findings in relation to visual analogue scale (VAS), Oswestry Disability Index (ODI), psychological-factor, sleep-quality, and Short-Form Health Survey (SF-36) scores among patients with central lumbar spinal stenosis (LSS) for the purpose of elucidating a correlation. METHODS: From July 2013 to May 2014, 117 consecutive patients with central LSS were included in this study. All of the MRIs were evaluated by one of the authors, and the evaluated items were the dural sac cross-sectional area (DSCSA), the number of stenotic levels, and the presence and levels of spondylolisthesis. The ODI, VAS, 36-item SF-36, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI) questionnaires were used to evaluate the participants. RESULTS: There are no correlations between the ODI, VAS, BDI, BAI, PSQI, and SF-36 scores and the minimum DSCSA; however, a significant correlation was found between the ODI scores and multilevel LSS. The BDI, BAI, and PSQI scores are higher for multilevel LSS compared with single-level LSS, but the difference of this mean value is not statistically significant. CONCLUSIONS: A significant correlation was shown between those patients with multilevel LSS and the ODI scores; however, significant correlations were not found between the MRI findings and the psychological factors pertaining to sleep and life qualities.

Prediction of the Development of Neurogenic Bladder in Patients with Lumbar Disc Herniation / 대한정형외과학회잡지

PURPOSE: To predict the development of a neurogenic bladder based on an analysis of the clinical and radiological findings in patients with lumbar disc herniations. MATERIALS AND METHODS: Twenty-six patients, who were suspected of having neurogenic bladders, underwent urodynamic testing. The anteroposterior diameters and the cross-sectional areas of the dural sacs at the herniated disc levels were measured by magnetic resonance imaging. Clinically, we evaluated lower back pain, radiating pain, saddle anesthesia, bladder function, motor weakness of the lower limbs, and the Japanese Orthopaedic Association (JOA) score. RESULTS: Thirteen (50%) of the 26 patients were diagnosed with positive neurogenic bladders. The average anteroposterior diameters of the dural sacs in group I (13 cases) with positive neurogenic bladders and in group II (13 cases) with negative neurogenic bladders, were 6.8 (range, 4-9) mm and 9.0 (range, 8-10) mm, respectively (p<0.001). When an anteroposterior diameter of 7 mm was used as the threshold value for differentiation between the anteroposterior diameter of the dural sac and a neurogenic bladder, the sensitivity and specificity were 61.5% and 100%, respectively. The average cross-sectional areas of the dural sacs in group I and group II were 74.9 (range 50-96) mm(2) and 86.2 (range 60-103) mm(2), respectively (p=0.069). When a cross-sectional area of 77 mm2 was used as the threshold value for differentiation between the cross-sectional area of the dural sac and a neurogenic bladder, the sensitivity and specificity were 61.5% and 84.6%, respectively. All 9 patients who had saddle anesthesia were diagnosed with positive neurogenic bladders. However, there was no statistical significance between the preoperative JOA score and the development of a neurogenic bladder. CONCLUSION: The anteroposterior diameter of the dural sac and saddle anesthesia might be important factors in predicting the presence of a neurogenic bladder in patients with lumbar disc herniation.

The Changes of the Dimension of Intervertebral Disc,-Neural Foramen and Spinal Canal after Anterior Lumbar Interbody Fusion in the Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: A prospective radiological assessment was conducted. OBJECTIVES: To analyze the changes in the heights of the intervertebral disc and neural foramen, and the diameters and areas of the dural sac and lateral recess following anterior lumbar interbody fusion and posterior fixation in lumbar degenerative disease. SUMMARY OF LITERATURE REVIEW: Anterior lumbar interbody fusion distracts from the height of the intervertebral disc and neural foramen and increase the area of the spinal canal. MATERIALS AND METHODS: A mini-open anterior lumbar interbody fusion and posterior fixation was performed on 40 cases between January 1999 and March 2002. The measured factors included the height of the intervertebral disc and neural foramen, the midsagittal and lateral diameters of the dural sac, the area of the dural sac and the diameter of the lateral recess. These were measured with calipers in 1mm reconstructive computed tomography images before and 6 months after the anterior lumbar interbody fusion. The measured factors were independently taken by three different orthopaedic surgeons. RESULTS: The heights of the intervertebral disc and neural foramen were increased by means of 39.1 and 18.7% respectively. The midsagittal diameter of the dural sac was increased by a mean of 11.6% and that of the lateral dural sac decreased by a mean of 3.7%. The area of the dural sac was increased by a mean of 8.1% and the diameter of lateral recess by a mean of 26.3%. There were statistically significant increases in all the measured factors, with the exception of the lateral diameter of the dural sac. CONCLUSIONS: Anterior lumbar interbody fusion significantly increases the heights of the intervertebral disc and neural foramen, the midsagittal diameter of the dural sac, the area of the dural sac and the diameter of the lateral recess, but not the lateral diameter of the dural sac.

Variations of End Level of the Dural Sac

OBJECTIVE: To determine the normal variations of end level of the dural sac in Korean subjects by magnetic resonance imaging (MRI). METHOD: The corresponding vertebral level of termination of the dural sac was evaluated by MRIs in two hundred adult Koreans (118 males, 82 females). We excluded the subjects with spine fracture, significant spinal deformity or spinal stenosis. End level of the dural sac was described in terms of their corresponding vertebral level. The vertebral levels were further divided into upper, middle, lower level, and intervertebral disc levels from the L5 to S3 vertebra. RESULTS: The most frequent end level of the dural sac was at the S1-S2 intervertebral disc level (22.5%) which was followed by the upper portion of S2 (21.5%) and the middle portion of S2 (17.0%). There was no significant difference in end level of the dural sac between male and female subjects. CONCLUSION: The dural sac most frequently ended at the S1-S2 intervertebral level and the end level of dural sac were located from the L5-S1 intervertebral level to the mid-point of S3. In a clinical setting, variable levels of the dural sac termination should be considered in an unexpected dural puncture during a caudal anesthesia or injection.

Abnormal Spontaneous Activities According to Type of Herniated Lumbar Disc and Anteroposterior Diameter of Dural Sac in MRI

OBJECTIVE: To assess the abnormal spontaneous activities in needle electromyography (EMG) according to the type of herniated lumbar disc and anteroposterior the diameter of dural sac in magnetic resonance imaging (MRI). METHOD: We performed the MRI on 120 patients with low back pain (LBP) and measured the midline anteroposterior diameter of dural sac in a MRI axial view. Fifty patients with a disc protrusion or extrusion in MRI were reviewed for the clinical findings on physical examination and assessed for the abnormal spontaneous activities (ASA) in needle EMG. RESULTS: Seventy cases with a normal finding in MRI did not have differences in a dural sac diameter regardless their age or sex. Fifty cases with a protrusion or extrusion in MRI showed that the dural sac size decreased more in an extrusion than in a protrusion, and more in a paracentral type than in a central type. The incidence of ASA in a needle EMG increased more in an extrusion than in a protrusion, and more in a paracentral type than in a central type. The incidence also increased according to the decrement of a dural sac diameter. The incidence of ASA were 100% in a group with both motor and sensory signs, 94% in a group with a motor sign, 86% in a group with a sensory sign, 26% in a group without motor or sensory sign. CONCLUSION: We concluded that the abnormalities in needle EMG must be correlated with the direction of herniated lumbar disc and anteroposterior diameter of the dural sac in MRI as well as clinical findings.

The Pathomorphologic Study of Spinal Stenosis as Seen on CT - Myelography of the Lumbar

This study has been examined different morphologic measurements in the evaluation of patients with lumbar spinal stenosis. Preoperative CT-Myelography from 30 patients who underwent surgery for central lumbar stenosis were analyzed. Based on this, we concluded as follows : 1) Bony measurement alone did not reliably identify patients with spinal stenosis. 2) Measurement of the transverse area of the dural sac on CT-Myelography was the most accurate method for identifying stenosis. 3) Lumbar myelography was still considered to have an important role in the valuation of a patient with stenosis because of correlation between the cross-sectional area of the dural sac and the anteroposterior diameter of the dural sac was excellent. 4) We identified soft-tissue problems as the main cause of stenosis. 5) The most common level of maximum stenosis was L4-5.

A Study of Functional Lumbar Myelography

Functional myelography, applying spinal movements(flexion-extension) in myelography, has been frequently used for accurate diagnosis of posture-related disorders such as herniated lumbar disc or spinal stenosis. Measurements were performed on functional myelographic findings of 62 patients, and in 24 cases surgically verified herniated lumber discs were present. The object of this study was to analyze changes in position and shape of the dural sac in spinal movements and confirm the clinical importance of functional myelography. The present study demonstrated that: 1) The anterior border of the dural sac was straight with flexion, but indented at the level of intervertebral space and this indentation was less prominent at L5-S1. 2) With extension, posterior indentation of the dural sac was more prominent at the level of the intervertebral space than the body, the A-P diameter of the dural sac was narrowed at all levels of the intervertebral spaces except L5-S1, and the dural sac moved anteriorly at the level of L5-S1 and all spinal bodies. 3) In surgically verified disc patients, anterior indentation of the dural sac was persistent in both flexion and extension views, and was more exaggerated with extension, but less prominent at L5-S1. In patient at L5-S1, anterior movement of the anterior dural border at the level of surgery was much decreased.

INFLUENCE OF FLEXION-EXTENSION MOTION OF LUMBAR SPINE ON LUMBOSACRAL DURAL SAC ?AN EXPERIMENTAL STUDY / 第二军医大学学报

In order to analyse the effects of flexion-extension motion of lumbar spine on the position and shape of lumbosacral dural sac, measurements were performed on 10 flexion/extension lateral myelograms of cadaver specimens of normal lumbar spine.It could be seen that from flexion to extension both sagittal diameter and length of the dural sac increased significantly, the dural sac moved caudally, and the sagittal diameter of the anterior epidural space decreased in the mid-vertebral level but increased in the inter vertebral level.The dynamic changes of the dural sac, the influence factors and the clinical relevances were discussed.