Role of redundant nerve roots in clinical manifestations of lumbar spine stenosis

Background

Redundant nerve roots (RNRs) are defined as elongated, thickened, and tortious appearing roots of the cauda equina secondary to lumbar spinal canal stenosis (LSCS). The study compared the clinical and radiological features of patients with LSCS with versus without RNR.

Methods

This retrospective study was performed on 55 patients who underwent decompressive surgery for degenerative LSCS. Patients were divided into two groups based on the presence of RNR in their preoperative magnetic resonance imaging, as evaluated by a radiologist blinded to the study design. Medical records were reviewed for basic demographic, clinical MR presentation, and outcomes utilizing Japanese Orthopaedic Association (JOA) scores.

Results

The mean age of enrolled patients was 57.1, with mean follow-up of 4.0 months. RNR was found in 22 (40%) of patients with LSCS. These patients were older than those patients without RNR (62.2 vs. 53.7). Interestingly, there were no statistically significant differences in clinical presentations, duration of symptoms, and outcomes using JOA scores between the two groups.

Conclusion

RNR is a relatively common radiological finding (i.e., 40%) in patients with LSCS. It is more likely to be observed in older patients. However, no significant differences were noted in clinical presentation and functional outcomes with respect to the presence or absence of RNR.

Analysis of Patterns of Gait Deterioration in Patients with Lumbar Spinal Stenosis

OBJECTIVE

Quantitative gait analysis has been established as a valuable tool for functional assessment and evaluation of intervention efficacy in lumbar spinal stenosis (LSS). We aimed to bolster the limited evidence on the specific aspects of gait that are altered in LSS.

METHODS

Fifteen patients with LSS and 15 healthy subjects performed a 30-m-long walk. Gait was assessed by video recording. Four spatiotemporal parameters were compared between groups: cadence, gait velocity, step length, and step duration.

RESULTS

Compared with healthy subjects, gait of patients with LSS demonstrated significant differences for all spatiotemporal parameters. Differences in mean cadence, step length, gait velocity, and step duration were -14%, -24%, -37%, and +16% between patients with LSS and healthy subjects.

CONCLUSIONS

This study demonstrated significant alterations in clinically measurable gait parameters in patients with LSS compared with healthy subjects. Future studies should assess the value of these gait parameters for objective clinical assessment of functional status and intervention efficacy through correlation with currently used subjective tools and comparison at preoperative and postoperative time points. Specific gait alterations identified in patients with LSS may be valuable for clinical objective assessment of functional status and intervention efficacy.

Decompressive Surgery for Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations

Objective

Lumbar spine stenosis is a common disease with a prevalence progressively increasing due to the aging of the population. Despite many papers having been published over the last decades, there still remain many doubts regarding its natural history and appropriate treatment. To overcome these problems and reach some globally accepted recommendations, the World Federation of Neurosurgical Society Spine Committee organized a consensus conference on this topic. This paper describes recommendations about the efficacy of surgical decompression, the difference between surgical techniques, and complications of surgery.

Methods

World Federation of Neurosurgical Society Spine Committee aimed to standardize clinical practice worldwide as much as possible and held a 2-round consensus conference on lumbar spinal stenosis. A team of expert spine surgeons reviewed literature regarding surgical treatment from over the last 10 years, and then drafted and voted on some statements based on the presented literature.

Results

Ten statements were voted. The committee agreed on the effectiveness of surgical decompression in patients with moderate-to-severe symptoms or with neurologic deficits. There was no consensus on the best surgical technique and, in particular, about the equivalence of microscopic techniques and an open approach. Regarding complications, we agreed that the most frequent complications are incidental durotomy and general complications in the elderly.

Conclusions

Surgical decompression represents the treatment of choice for symptomatic lumbar spinal stenosis with a low complication rate. However, which surgical technique is the best is still under debate. Further studies with standardized outcome measures are needed to understand the real complication rate and frequency of different unwanted events.

Clinical Gait Evaluation of Patients with Lumbar Spine Stenosis

OBJECTIVE

The third generation Intelligent Device for Energy Expenditure and Activity (IDEEA3, MiniSun, CA) has been developed for clinical gait evaluation, and this study was designed to evaluate the accuracy and reliability of IDEEA3 for the gait measurement of lumbar spinal stenosis (LSS) patients.

METHODS

Twelve healthy volunteers were recruited to compare gait cycle, cadence, step length, velocity, and number of steps between a motion analysis system and a high-speed video camera. Twenty hospitalized LSS patients were recruited for the comparison of the five parameters between the IDEEA3 and GoPro camera. Paired t-test, intraclass correlation coefficient, concordance correlation coefficient, and Bland-Altman plots were used for the data analysis.

RESULTS

The ratios of GoPro camera results to motion analysis system results, and the ratios of IDEEA3 results to GoPro camera results were all around 1.00. All P-values of paired t-tests for gait cycle, cadence, step length, and velocity were greater than 0.05, while all the ICC and CCC results were above 0.950 with P < 0.001.

CONCLUSIONS

The measurements for gait cycle, cadence, step length, velocity, and number of steps with the GoPro camera are highly consistent with the measurements with the motion analysis system. The measurements for IDEEA3 are consistent with those for the GoPro camera. IDEEA3 can be effectively used in the gait measurement of LSS patients.