The observation and clinical significance of redundant nerve roots of cauda equina in lumbar spinal stenosis
REN Tao， ZHENG Ming-hui， WANG Xiang， FENG Shi-feng，QU Dong-bin
Chinese Journal of Clinical Anatomy ›› 2018, Vol. 36 ›› Issue (2) : 221-225.
The observation and clinical significance of redundant nerve roots of cauda equina in lumbar spinal stenosis
Objective To observe the morphology of Redundant Nerve Roots（RNRs）of cauda equina in lumbar spinal stenosis and to discuss the clinical significance of RNRs. Methods From January to November 2016, 134 patients with single segmental lumbar spinal stenosis were treated in our hospital and received routine MRI scan. Based on sagittal MRI, cauda equina can be divided into RNRs（+）and RNRs（-）. The median sagittal diameter, the effective sagittal diameter and the effective cross-sectional canal area of the stenotic segment of spinal canal were measured. The relationship between RNRs（+）and the degree of stenosis was analyzed statistically. Results Among 134 patients , 61 males and 73 females, aged 24~80 years (mean age 54.4±13.6 years), RNRs was positive in 43 cases, and negative in 91 cases. The RNRs（+） morphology can be divided into three types： "stripe" type in 29 cases (67.44%, 29/43), "grape beads" type in 6 cases (13.95%, 6/43), and "serpentine "type in 8 cases (18.60%, 8 / 43).The effective cross-sectional canal area in RNRs（+） group was significantly smaller than that in RNRs（-）(P<0.05), but no significant difference was found between median sagittal diameter and effective sagittal diameter in both groups (P>0.05) . Conclusion RNRs of cauda equina can be found in severe lumbar spinal stenosis and it is associated with absolute stenosis of the spinal canal. Therefore, it is suggested RNRs can be used as an indicator for surgical treatment of lumbar spinal stenosis.
[1] 张超，周恒星，冯世庆，等. 老年腰椎管狭窄症的手术疗效分析[J]. 中华外科杂志, 2013, 51(9): 816-820.
[2] 陈通，李林宏，钱学华，等. 侧隐窝横、矢径测量在腰椎管狭窄症的诊断意义[J]. 中国临床解剖学杂志, 2010, 28(5): 483-486.
[3] 赵兴，范顺武. 若干未受重视的腰椎管狭窄的MRI表征[J]. 中华骨科杂志, 2016, 36(22):1405-1409.
[4] VERBIEST H. A radicular syndrome from developmental narrowing of the lumbar vertebral canal[J]. J Bone Joint Surg Br, 1954, 36-B(2):230-237.
[5] Cressman MR, Pawl RP. Serpentine myelographic defect caused by a redundant nerve root.Case report[J]. J NEUROSURG, 1968, 28(4):391-393.
[6] Zheng F, Farmer JC, Sandhu HS, et al. A novel method for the quantitative evaluation of lumbar spinal stenosis[J]. HSS J, 2006, 2(2):136-140.
[7] Yang SM, Park HK, Cho SJ, et al. Redundant nerve roots of cauda equina mimicking intradural disc herniation: a case report[J]. Korean J Spine, 2013, 10(1):41-43.
[8] 连平，孙荣华，杨维权，等. 腰椎椎管与硬膜囊横截面积及其动态变化的实验研究[J]. 中华外科杂志, 1995, 33（3）:151-154.
[9] Malmivaara A, Slatis P, Heliovaara M, et al. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial[J]. Spine (Phila Pa 1976), 2007, 32(1):1-8.
[10]Pau A, Turtas S. Redundant nerve roots of the cauda equina. A case report[J]. Acta Neurochir (Wien), 1976, 33(3-4):311-317.
[11]Dora C, Walchli B, Elfering A, et al. The significance of spinal canal dimensions in discriminating symptomatic from asymptomatic disc herniations[J]. Eur Spine J, 2002, 11(6):575-581.
[12]Ooi Y, Mita F, Satoh Y. Myeloscopic study on lumbar spinal canal stenosis with special reference to intermittent claudication[J]. Spine (Phila Pa 1976), 1990, 15(6):544-549.
[13]Min JH, Jang JS, Lee SH. Clinical significance of redundant nerve roots of the cauda equina in lumbar spinal stenosis[J]. Clin Neurol Neurosurg, 2008, 110(1):14-18.
[14]Chen J, Wang J, Wang B, et al. Post-surgical functional recovery, lumbar lordosis, and range of motion associated with MR-detectable redundant nerve roots in lumbar spinal stenosis[J]. Clin Neurol Neurosurg, 2016, 140:79-84.
[15] 贾连顺. 重视急性马尾神经综合征的早期诊断与治疗[J]. 中华外科杂志, 2008, 46(21):1665-1666.
/
| 〈 |
|
〉 |
