Lee Jong-Hyuk, Sim Ki-Choon, Kwon Hyun-Jung, Kim Jae-Won, Lee Gunn, Cho Seong-Sik, Choi Seong-Soo, Leem Jeong-Gil
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine.
Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul.
Medicine (Baltimore). 2019 Mar;98(9):e14490. doi: 10.1097/MD.0000000000014490.
Redundant nerve root syndrome (RNRS) is a phenomenon characterized by the presence of elongated, enlarged, tortuous nerve roots in the lumbar subarachnoid space. It is unclear whether RNRS is caused by spinal stenosis or causes these symptoms.This study evaluated the effects of lumbar epidural steroid injection (LESI) on patients with RNRS and assessed factors associated with RNRS. This retrospective observational cohort study was conducted at a single pain clinic of a university hospital.The medical records of 172 outpatients presenting with low back and/or leg pain from July to December 2014 were analyzed. Pain intensity (numeric rating scale [NRS]) and functional status were assessed at baseline and 2, 4, and 12 weeks after the LESI. Patients were considered moderate responders if they showed a 3-point or >30% reduction in baseline NRS, or said "better than 30%," "a little better," or "I feel an effect." Patients were considered substantial responders if they showed a 5-point or >50% reduction in baseline NRS, or said "better than 50%," "very good," or "much better." Generalized estimating equation (GEE) analysis was performed to identify the factors associated with moderate response to LESI. Factors associated with RNRS were also determined by logistic regression analysis.The proportions of both moderate and substantial responders at 2, 4, and 12 weeks were significantly lower in patients with than without RNRS. GEE analysis showed that RNRS were the only factor significantly associated with moderate response to LESI (OR = 0.400; 95% CI, 0.253-0.632; P < .001). The distance from the conus medullaris to the closest level of stenosis was shorter in patients with than without RNRS (P < .001) and was the only independent factor associated with RNRS on multivariate logistic regression analysis (OR = 0.972; P < .001).LESI was less effective in patients with than without RNRS. The only independent factor significantly associated with RNRS was the distance from the conus medullaris to the nearest moderate stenosis.
冗余神经根综合征（RNRS）是一种以腰椎蛛网膜下腔内神经根拉长、增粗、迂曲为特征的现象。目前尚不清楚RNRS是由椎管狭窄引起还是导致这些症状。本研究评估了腰椎硬膜外类固醇注射（LESI）对RNRS患者的影响，并评估了与RNRS相关的因素。这项回顾性观察队列研究在一家大学医院的单一疼痛诊所进行。分析了2014年7月至12月期间172例出现腰背痛和/或腿痛的门诊患者的病历。在基线以及LESI后2周、4周和12周评估疼痛强度（数字评定量表[NRS]）和功能状态。如果患者基线NRS降低3分或降低>30%，或者表示“比30%好”“稍好”或“我感觉有效果”，则被视为中度反应者。如果患者基线NRS降低5分或降低>50%，或者表示“比50%好”“非常好”或“好多了”，则被视为显著反应者。进行广义估计方程（GEE）分析以确定与LESI中度反应相关的因素。还通过逻辑回归分析确定了与RNRS相关的因素。与无RNRS的患者相比，有RNRS的患者在2周、4周和12周时中度和显著反应者的比例显著更低。GEE分析表明，RNRS是与LESI中度反应显著相关的唯一因素（OR = 0.400；95%CI，0.253 - 0.632；P <.001）。与无RNRS的患者相比，有RNRS的患者脊髓圆锥至最接近狭窄水平的距离更短（P <.001），并且是多因素逻辑回归分析中与RNRS相关的唯一独立因素（OR = 0.972；P <.001）。与无RNRS的患者相比，LESI对有RNRS的患者效果更差。与RNRS显著相关的唯一独立因素是脊髓圆锥至最近中度狭窄的距离。
