Park Seoyeong, Hong Sung Hwan, Chung Sun Gun, Kim Keewon
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Muscle Nerve. 2024 Jun;69(6):691-698. doi: 10.1002/mus.28094. Epub 2024 Mar 28.
INTRODUCTION/AIMS: Redundant 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.
We 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.
Among 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.
The 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.
引言/目的：冗余神经根（RNRs）是继发于退行性脊柱狭窄而形成的异常延长和迂曲的神经根。RNRs与减压手术后较差的临床结果相关；然而，关于其临床特征的研究有限。本研究旨在探讨RNRs与肌电图上的失神经电位之间的关联，即异常自发电活动（ASA）。
我们回顾性分析了2020年1月至2023年3月期间接受下肢电诊断检查的患者的数据。其中，纳入磁共振成像显示有腰椎中央椎管狭窄的患者。我们分析了临床和影像学数据，包括ASA的存在情况，并根据RNRs的存在情况进行比较。采用多变量逻辑回归分析来确定与ASA发生相关的因素。
在筛查的2003例患者中，193例纳入研究。RNRs与高龄（p <.001）、症状持续时间较长（p =.009）、狭窄水平处硬脊膜囊横截面积较小（p <.001）以及ASA频率较高（p <.001）相关。ASA发生的较高概率与RNRs严重程度增加相关（p <.001）。在多变量逻辑回归分析中，ASA的发生与较小的横截面积、多个狭窄部位以及重度RNRs相关。
RNRs的存在，尤其是重度RNRs，被确定为肌电图上ASA发生的重要危险因素。这一发现可能有助于医生评估中央椎管狭窄患者的预后。
