Franssen Eric, Weber Clemens, Myklebust Tor Åge, Austevoll Ivar Magne, Brisby Helena, Hellum Christian, Storheim Kjersti, Aaen Jørn, Banitalebi Hasan, Brox Jens Ivar, Indrekvam Kari, Hermansen Erland
Department of Orthopedics, Stavanger University Hospital, Stavanger, Norway.
Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway.
Spine (Phila Pa 1976). 2025 Jul 15;50(14):941-947. doi: 10.1097/BRS.0000000000005160. Epub 2024 Sep 26.
Post hoc analysis of data from a randomized clinical trial.
To compare preoperative symptoms of patients with lumbar spinal stenosis with and without redundant nerve roots (RNRs), and to compare the change in clinical outcomes between those two groups 2 years after decompression surgery.
RNRs are often seen on magnetic resonance imaging in patients with spinal stenosis. Previous studies have reported that patients with RNR are older and have worse symptoms at baseline. A meta-analysis from 2018 concluded that this radiologic sign could be seen as a negative predictor of outcome. High-quality prospective studies are lacking.
Patient characteristics and reported pain and function scores were compared between lumbar spinal stenosis groups with (RNR+) and without RNR (RNR-) at baseline and after 2 years of follow-up. The primary outcome was the mean change in the Oswestry Disability Score (Oswestry Disability Index). Secondary outcomes included mean change in scores of the Zurich Claudication Questionnaire and the Numerical Rating Scale for leg and back pains.
Out of 416 patients included in the present analysis, 163 (39%) had RNR at baseline. Both groups were similar in regard to patient age, smoking habits, Body Mass Index, and duration of symptoms. Both groups also showed similar pain and function scores at baseline. The RNR+ group contained a significantly higher proportion of men, patients with severe stenosis and multiple stenotic levels on magnetic resonance imaging. At a 2-year follow-up, the mean change of the Oswestry Disability Index was -22.1 in the RNR+ group and -17.4 in the RNR- group [mean difference: 4.7 (95% CI: 1.3 to 8.2); P = 0.007]. Statistically significant differences were also found for secondary outcomes Zurich Claudication Questionnaire, and Numerical Rating Scale leg and back pains favoring the RNR+ group.
Patients with RNR had similar baseline characteristics and similar symptoms as patients without. RNR before surgery was associated with better clinical improvement 2 years after decompression.
对一项随机临床试验的数据进行事后分析。
比较有和没有冗余神经根（RNRs）的腰椎管狭窄症患者的术前症状，并比较减压手术后两年这两组患者临床结局的变化。
在椎管狭窄症患者的磁共振成像中经常可以看到RNRs。先前的研究报告称，有RNRs的患者年龄较大，且基线时症状更严重。2018年的一项荟萃分析得出结论，这种放射学征象可被视为结局的负性预测指标。目前缺乏高质量的前瞻性研究。
比较腰椎管狭窄症患者中基线时和随访2年后有RNR（RNR+）和无RNR（RNR-）两组的患者特征以及报告的疼痛和功能评分。主要结局是奥斯威斯利功能障碍评分（Oswestry功能障碍指数）的平均变化。次要结局包括苏黎世跛行问卷评分以及腿部和背部疼痛数字评定量表评分的平均变化。
在本分析纳入的416例患者中，163例（39%）在基线时有RNRs。两组在患者年龄、吸烟习惯、体重指数和症状持续时间方面相似。两组在基线时的疼痛和功能评分也相似。RNR+组男性、严重狭窄患者以及磁共振成像显示多节段狭窄的患者比例显著更高。在2年随访时，RNR+组奥斯威斯利功能障碍指数的平均变化为-22.1，RNR-组为-17.4 [平均差异：4.7（95%CI：1.3至8.2）；P = 0.007]。次要结局苏黎世跛行问卷以及腿部和背部疼痛数字评定量表在统计学上也有显著差异，均有利于RNR+组。
有RNRs的患者与没有RNRs的患者具有相似的基线特征和症状。术前存在RNRs与减压术后2年更好的临床改善相关。
