Lumbosacral Nerve Root Compression Research Articles

Application of Magnetic Resonance Diffusion Tensor Imaging in Diagnosis of Lumbosacral Nerve Root Compression

The aim of this study was to assess the value of 3.0T magnetic resonance (MR) Diffusion tensor imaging (DTI) in the diagnosis of lumbosacral nerve root compression. The radiology reports, and clinical records of 34 patients with nerve root compression caused by lumbar disc herniation or bulging and 21 healthy volunteers who had undergone magnetic resonance imaging (MRI) and DTI scan were retrospectively reviewed. The differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) between compressed and non-compressed nerve roots from patients and the normal nerve roots from healthy volunteers were compared. Meanwhile, the nerve root fiber bundles were observed and analyzed. The average FA and ADC values of the compressed nerve roots were 0.254 ± 0.307 and 1.892 ± 0.346 10^-3mm2/s, respectively. The average FA and ADC values of the non-compressed nerve roots were 0.377 ± 0.659 and 1.353 ± 0.344 10^-3mm2/s, respectively. The FA value of compressed nerve roots was significantly lower than that of non-compressed nerve roots (P < 0.01). The ADC value of compressed nerve roots was significantly higher than that of non-compressed nerve roots. There were no significant differences between the left and right nerve roots of normal volunteers in FA and ADC values (P > 0.05). The nerve roots at different levels of L3-S1 had significantly different FA and ADC values (P < 0.01). Incomplete fiber bundles with extrusion deformation, displacement or partial defect were observed in the compressed nerve root fiber bundles. The real diagnosis of the clinical situation of the nerve can provide neuroscientists with an important computer tool to help them infer and understand the possible working mechanism from the experimental data of behavior and electrophysiology. The compressed lumbosacral nerve roots can be accurately localized through 3.0T magnetic resonance DTI, which is instructive for accurate clinical diagnosis and preoperative localization.

The value of contrast-enhanced three-dimensional isotropic T2-weighted turbo spin-echo SPACE sequence in the diagnosis of patients with lumbosacral nerve root compression

To investigate the diagnostic value of contrast-enhanced three-dimensional (3D) T2-weighted turbo spin-echo SPACE (T2-SPACE) sequence in LNRC. A total of 90 surgically confirmed LNRC patients with 165 explored nerve roots were enrolled in this study. Diagnostic values were quantified using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. The consistency between 2D MRI and 3D T2-SPACE MRI was quantified using kappa test. The compression of specific branch in nerve root was evaluated on 2D MRI, 3D T2-SPACE MRI, and surgical findings. The pedicle height, vertebral body height (VH), proximal tilting angle of nerve root (PTA) were measured on MR images. The sensitivity, specificity, PPV, NPV, and accuracy by 2D MRI were 78.3%, 72.7%, 94.9%, 34.0%, and 77.6%, respectively. For 3D T2-SPACE MRI imaging, the sensitivity, specificity, PPV, NPV, and accuracy were 91.6%, 86.4%, 97.8%, 61.3%, and 90.9%, respectively. 2D MRI and 3D T2-SPACE MRI for detection of intra-foramen and extra-foramen nerve compression showed poor homogeneity (Kappa = 0.333, Kappa = 0.276, respectively). Smaller VHs and larger PTAs could be indicators for the diagnosis of foraminal nerve root compression. 3D T2-SPACE MRI had a higher sensitivity, specificity, PPV, NPV, and accuracy than 2D MRI for detecting LNRC. The 3D T2-SPACE scan could be a good substitute to routine 2D MRI in LNRC diagnosis, especially for foraminal nerve root compression patients. III.

Diagnostic utility of patient history, clinical examination and screening tool data to identify neuropathic pain in low back related leg pain: a systematic review and narrative synthesis

BackgroundLow back-related leg pain (LBLP) is a challenge for healthcare providers to manage. Neuropathic pain (NP) is highly prevalent in presentations of LBLP and an accurate diagnosis of NP in LBLP is essential to ensure appropriate intervention. In the absence of a gold standard, the objective of this systematic review was to evaluate the diagnostic utility of patient history, clinical examination and screening tool data for identifying NP in LBLP.MethodsThis systematic review is reported in line with PRISMA and followed a pre-defined and published protocol. CINAHL, EMBASE, MEDLINE, Web of Science, Cochrane Library, AMED, Pedro and PubMed databases, key journals and the grey literature were searched from inception to 31 July 2019. Eligible studies included any study design reporting primary diagnostic data on the diagnostic utility of patient history, clinical examination or screening tool data to identify NP in LBLP, in an adult population. Two independent reviewers searched information sources, assessed risk of bias (QUADAS-2) and used GRADE to assess overall quality of evidence.ResultsFrom 762 studies, 11 studies were included. Nine studies out of the 11 were at risk of bias. Moderate level evidence supports a cluster of eight signs (age, duration of disease, paroxysmal pain, pain worse in leg than back, typical dermatomal distribution, worse on coughing/sneezing/straining, finger to floor distance and paresis) for diagnosing lumbosacral nerve root compression, demonstrating moderate/high sensitivity (72%) and specificity (80%) values. Moderate level evidence supports the use of the StEP tool for diagnosing lumbar radicular pain, demonstrating high sensitivity (92%) and specificity (97%) values.ConclusionsOverall low-moderate level evidence supports the diagnostic utility of patient history, clinical examination and screening tool data to identify NP in LBLP. The weak evidence base is largely due to methodological flaws and indirectness regarding applicability of the included studies. The most promising diagnostic tools include a cluster of 8 patient history/clinical examination signs and the StEP tool. Low risk of bias and high level of evidence diagnostic utility studies are needed, in order for stronger recommendations to be made.

The clinical features and outcome of scan-negative and scan-positive cases in suspected cauda equina syndrome: a retrospective study of 276 patients

BackgroundThe majority of patients presenting with suspected clinical cauda equina syndrome (CES) have no identifiable structural cause for their symptoms (‘scan-negative’ CES). Understanding these patients aids clinical differentiation and management in CES.MethodsA retrospective electronic note review was undertaken of patients presenting with suspected CES, defined as ≥ 1 of acute bladder, bowel, sexual dysfunction or saddle numbness, to a regional neurosciences centre. We investigated radiology, clinical features, psychiatric and functional disorder comorbidities and outcome of patients with ‘scan-negative’ CES and patients with MRI confirmed compression of the cauda equina (‘scan-positive’ CES).Results276 patients were seen over 16 months. There were three main radiologically defined patient groups: (1) ‘scan-positive’ CES (n = 78, mean age 48 years, 56% female), (2) ‘scan-negative’ CES without central canal stenosis but with lumbosacral nerve root compression not explaining the clinical presentation (n = 87, mean age 43 years, 68% female) and (3) ‘scan-negative’ CES without neural compromise (n = 104, mean age 42 years, 70% female). In the two ‘scan-negative’ groups (no neural compromise and nerve root compression), there were higher rates of functional disorders (37% and 29% vs. 9%), functional neurological disorders (12% and 11% vs 0%) and psychiatric comorbidity (53% and 40% vs 20%). On follow-up (mean 13–16 months), only 1 of the 191 patients with ‘scan-negative’ CES was diagnosed with an explanatory neurological disorder (transverse myelitis).ConclusionsThe data support a model in which scan-negative cauda equina syndrome arises as an end pathway of acute pain, sometimes with partly structural findings and vulnerability to functional disorders.

Study on lumbosacral nerve root compression using DTI.

Diffusion tensor imaging (DTI) can objectively describe the distribution of nerve roots in morphology, and provide a set of objective reference data on the quantitative indicators. The present study aimed to investigate the value of DTI in lumbosacral nerve root compression in patients with lumbar intervertebral disc degeneration. DTI was performed in 45 patients with lumbar intervertebral disc degeneration. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured in compressed and normal nerve roots. Fiber tracking imaging was also applied to observe the lumbosacral nerve roots. ADC value was significantly lower in the compressed group (1.314±0.14 mm2/sec) compared to in the uncompressed group (1.794±0.11 mm2/sec) (P<0.05). The FA value was significantly lower in the compressed group (0.196±0.020) compared to the uncompressed group (0.272±0.016) (P<0.05). DTI can evidently reveal the compressed nerve roots. DTI could be used to evaluate the lumbosacral nerve injury in patients with lumbar intervertebral disc degeneration to quantitatively assess nerve roots.

A diagnostic study in patients with sciatica establishing the importance of localization of worsening of pain during coughing, sneezing and straining to assess nerve root compression on MRI.

To test whether the localization of worsening of pain during coughing, sneezing and straining matters in the assessment of lumbosacral nerve root compression or disc herniation on MRI. Recently the diagnostic accuracy of history items to assess disc herniation or nerve root compression on magnetic resonance imaging (MRI) was investigated. A total of 395 adult patients with severe sciatica of 6-12weeks duration were included in this study. The question regarding the influence of coughing, sneezing and straining on the intensity of pain could be answered on a 4 point scale: no worsening of pain, worsening of back pain, worsening of leg pain, worsening of back and leg pain. Diagnostic odds ratio's (DORs) were calculated for the various dichotomization options. The DOR changed into significant values when the answer option was more narrowed to worsening of leg pain. The highest DOR was observed for the answer option 'worsening of leg pain' with a DOR of 2.28 (95% CI 1.28-4.04) for the presence of nerve root compression and a DOR of 2.50 (95% CI 1.27-4.90) for the presence of a herniated disc on MRI. Worsening of leg pain during coughing, sneezing or straining has a significant diagnostic value for the presence of nerve root compression and disc herniation on MRI in patients with sciatica. This study also highlights the importance of the formulation of answer options in history taking.

The value of lumbar dorsal root ganglion blocks in predicting the response to decompressive surgery in patients with diagnostic doubt

Background contextPain as a consequence of nerve root compression may not be easy to diagnose. Degenerative changes causing nerve root compression on magnetic resonance imaging (MRI) are common but not necessarily symptomatic while the distribution of pain attributable to a particular nerve root is variable. Selective dorsal root ganglion blocks (DRGBs) have been used in these situations to aid the diagnostic process, although their use remains controversial. PurposeWe sought to investigate the positive predictive value of DRGBs in predicting response to decompressive surgery on a particular nerve root in a patient cohort with diagnostic uncertainty after clinical examination and MRI. Study design/settingThis was a retrospective review of prospectively collected data on 100 consecutive patients. MethodsOne hundred consecutive patients who underwent diagnostic DRGB under the senior author were identified retrospectively. Clinical records were reviewed for the reason for diagnostic uncertainty, level assessed, whether the DRGB reproduced pain typical for the patient's symptoms, whether there was anatomically appropriate sensory and motor disturbance, whether good pain relief was achieved, and whether they had good response to surgery. ResultsOf 100 patients recruited, four were removed from analysis owing to inadequate surgical decompression proven on postoperative MRI. Of the remaining 96 patients, 74 achieved immediate relief in their symptoms after DRGB. Fifty-one patients underwent surgical decompression after a successful root block; 41 patients achieved a good result from this surgery, and 10 did not. Nine patients who had no relief in their symptoms from DRGB still underwent surgery to decompress the same nerve root; six patients had relief of their symptoms from surgery, two did not respond, and one was lost to follow-up. The most common reason for diagnostic uncertainty was multilevel disease (74%) followed by patients with atypical pain (23%). The most common level assessed was the L5 nerve root. The positive predictive value was found to be 80.4%, the negative predictive value was 22.2%, with a sensitivity of 85.4% and a specificity of 16.7%. ConclusionsIn patients with diagnostic doubt, a positive DRGB is a good predictor of a positive outcome after surgery to decompress that nerve root. However, the negative predictive value is poor. This result could almost certainly be improved if there was a better definition of what constitutes a positive, and more importantly a negative, DRGB result. In the meantime, DRGBs are a useful adjunct in predicting the outcome of decompressive surgery in people with pain as a consequence of potential lumbosacral nerve root compression.

Changes in lumbosacral spinal nerve roots on diffusion tensor imaging in spinal stenosis.

Lumbosacral degenerative disc disease is a common cause of lower back and leg pain. Conventional T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) scans are commonly used to image spinal cord degeneration. However, these modalities are unable to image the entire lumbosacral spinal nerve roots. Thus, in the present study, we assessed the potential of diffusion tensor imaging (DTI) for quantitative assessment of compressed lumbosacral spinal nerve roots. Subjects were 20 young healthy volunteers and 31 patients with lumbosacral stenosis. T2WI showed that the residual dural sac area was less than two-thirds that of the corresponding normal area in patients from L3 to S1 stenosis. On T1WI and T2WI, 74 lumbosacral spinal nerve roots from 31 patients showed compression changes. DTI showed thinning and distortion in 36 lumbosacral spinal nerve roots (49%) and abruption in 17 lumbosacral spinal nerve roots (23%). Moreover, fractional anisotropy values were reduced in the lumbosacral spinal nerve roots of patients with lumbosacral stenosis. These findings suggest that DTI can objectively and quantitatively evaluate the severity of lumbosacral spinal nerve root compression.

Is NICE guidance for identifying lumbar nerve root compression misguided?

To determine the extent to which the clinical manifestations of a cohort of people undergoing surgery for lumbosacral nerve root compression satisfy those described in The National Institute for Health and Care Excellence (NICE) guidance. We studied consecutive admissions for lumbar nerve root decompression surgery at two neurosurgical units. Pre-operatively, each person's clinical manifestations were documented and compared with NICE's description. Post-operatively, at three time points (within 48 h, 3 months, 12 months), each person rated their symptoms as either better, the same, or worse. Pre-operatively, one person (0.8%), from 123 admissions, under 20 different consultant neurosurgeons, had manifestations consistent with NICE's clinical description of lumbar nerve root compression. Post-operatively, self-reported benefit associated with surgery appeared high, at all three time points (78-91%), supporting the diagnosis of symptomatic nerve root compression and the value of surgery. In this small sample, from two units, NICE's description of the clinical manifestations of lumbar nerve root compression did not describe 99% of people having surgery for it. Using NICE's definition to triage people with low back pain could result in prolonged symptoms and delayed treatment. Diagnosing lumbar nerve root compression is complex. NICE's guidance requires examination.

Diagnostic accuracy of history taking to assess lumbosacral nerve root compression

Background contextThe diagnosis of sciatica is primarily based on history and physical examination. Most physical tests used in isolation show poor diagnostic accuracy. Little is known about the diagnostic accuracy of history items. PurposeTo assess the diagnostic accuracy of history taking for the presence of lumbosacral nerve root compression or disc herniation on magnetic resonance imaging in patients with sciatica. Study designCross-sectional diagnostic study. Patient sampleA total of 395 adult patients with severe disabling radicular leg pain of 6 to 12 weeks duration were included. Outcome measuresLumbosacral nerve root compression and disc herniation on magnetic resonance imaging were independently assessed by two neuroradiologists and one neurosurgeon blinded to any clinical information. MethodsData were prospectively collected in nine hospitals. History was taken according to a standardized protocol. There were no study-specific conflicts of interest. ResultsExploring the diagnostic odds ratio of 20 history items revealed a significant contribution in diagnosing nerve root compression for “male sex,” “pain worse in leg than in back,” and “a non-sudden onset.” A significant contribution to the diagnosis of a herniated disc was found for “body mass index <30,” “a non-sudden onset,” and “sensory loss.” Multivariate logistic regression analysis of six history items pre-selected from the literature (age, gender, pain worse in leg than in back, sensory loss, muscle weakness, and more pain on coughing/sneezing/straining) revealed an area under the receiver operating characteristic curve of 0.65 (95% confidence interval, 0.58–0.71) for the model diagnosing nerve root compression and an area under the receiver operating characteristic curve of 0.66 (95% confidence interval, 0.58–0.74) for the model diagnosing disc herniation. ConclusionsA few history items used in isolation had significant diagnostic value and the diagnostic accuracy of a model with six pre-selected items was poor.

The management of weakness caused by lumbar and lumbosacral nerve root compression

Spinal stenosis and disc herniation are the two most frequent causes of lumbosacral nerve root compression. This can result in muscle weakness and present with or without pain. The difficulty when managing patients with these conditions is knowing when surgery is better than non-operative treatment: the evidence is controversial. Younger patients with a lesser degree of weakness for a shorter period of time have been shown to respond better to surgical treatment than older patients with greater weakness for longer. However, they also constitute a group that fares better without surgery. The main indication for surgical treatment in the management of patients with lumbosacral nerve root compression should be pain rather than weakness.

Clinical significance of buttock trigger points appearing in lumbosacral nerve root compression

Clinical significance of buttock trigger points appearing in lumbosacral nerve root compression

Various history and physical examination characteristics predicted nerve root compression

(2002) J Neurol Neurosurg Psychiatry 72, 630; Vroomen PC, de Krom MC, Wilmink JK, et al. . Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve...

Detection of lumbosacral nerve root compression with a novel composite nerve conduction measurement.

Multivariate logistic regression techniques were used to develop a composite nerve conduction measurement that detects lumbosacral (L5, S1, or both) nerve root compression. To evaluate the diagnostic efficacy of a composite nerve conduction measurement for detection of lumbosacral nerve root compression. Nerve root involvement is characterized by clinical abnormalities and confirmed by radiologic and electrodiagnostic studies. Imaging studies visualize structural abnormalities; however, they are associated with high false-positive rates. Electrodiagnostic methods assess the physiologic integrity of the nerve roots. One form of electrodiagnostic testing, nerve conduction studies, is widely used for evaluation of musculoskeletal and neuromuscular complaints. Although similar clinical value is expected for the evaluation of nerve root compromise, prior applications of nerve conduction studies have yielded widely varying results. Two groups of subjects were compared. The L5-S1 compression group was composed of 25 patients with magnetic resonance imaging-confirmed lumbosacral (L5, S1, or both) nerve root compression and symptoms in the appropriate segmental distribution. The majority of subjects (22) had at least one of the following findings on physical examination: positive straight-leg raise test, diminished ankle reflexes, sensory loss, or weakness. The control group consisted of 35 asymptomatic individuals with no history of radiculopathy or potentially confounding neuropathology. The posterior tibial and deep peroneal nerves were evaluated bilaterally in all study subjects using standard nerve conduction procedures, which consisted of the measurement of distal motor latencies and F-wave latencies that assess nerve root pathophysiology. A composite nerve conduction measurement was determined using multivariate logistic regression analysis. The efficacy of the composite measurement was assessed by receiver operating characteristic curve analysis and by the diagnostic sensitivity and specificity. Five F-wave latency parameters (peroneal mean F-wave latency, odds ratio = 0.42; peroneal seventh F-wave latency decile, odds ratio = 2.71; tibial mean F-wave latency, odds ratio = 8.90; tibial first F-wave latency decile, odds ratio = 0.47; tibial maximum F-wave latency, odds ratio = 0.44) were found to be predictive of nerve root compression. A composite nerve conduction measurement, NC composite, constructed from these five parameters (NC composite = exp(phi)/(1 + exp(phi)), phi = -31.2 + 1.0 * Per7 Decile - 0.88 * PerMean + 2.2 * TibMean - 0.88 * Tib1 Decile - 0.83 * TibMax) yielded an area under the receiver operating characteristic curve of 0.91. At a threshold of 0.20, NC composite had a diagnostic specificity of 84.3% and a sensitivity of 83.3%. This preliminary study suggests that a novel composite nerve conduction measurement, based on F-wave latency parameters, may be highly effective at detecting magnetic resonance imaging-confirmed lumbosacral nerve root compression. Because these measurements provide objective evidence of functional nerve root compromise and are noninvasive, they may be of diagnostic value to clinicians evaluating patients presenting with low back and leg pain.

Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression

Objective: To evaluate patient characteristics, symptoms, and examination findings in the clinical diagnosis of lumbosacral nerve root compression causing sciatica. Methods: The study involved 274 patients with pain radiating into...

Diagnostic Value of Clinical Findings in Sciatica Due to Disk Herniation

History and physical examination are typically used to determine the presence of lumbosacral nerve root compression due to disk herniation in patients

Spinal evoked magnetic fields in patients with unilateral lumbosacral nerve root compression

Spinal evoked magnetic fields in patients with unilateral lumbosacral nerve root compression

Dimensions of the spinal canal in individuals symptomatic and non-symptomatic for sciatica: a CT study.

Measurements obtained in 50 spinal CT studies of patients referred for suspected lumbo-sacral nerve root compression, were compared to those of a group of 30 individuals asymptomatic in this respect, who had been referred for abdominal pathology. Transverse ligamentous interfacet and transverse dural dimensions were significantly reduced in the sciatica group, with usually normal interpedicular and sagittal dimensions ruling out idiopathic developmental stenosis. The borderline value for ligamentous interfacet distance (ILD) at L4-5 appeared to be 11 mm.

Isolated hypogastric artery aneurysms.

Isolated hypogastric artery aneurysms are unusual variants of aortoiliac aneurysmal disease. These vascular lesions can pose a diagnostic dilemma and are difficult to manage operatively. Five patients with six isolated hypogastric artery aneurysms were treated at UCLA Hospital, Los Angeles, in addition to 59 patients with 76 isolated hypogastric artery aneurysms previously described in the literature, to form a collected series. Although the aneurysms were asymptomatic in 43% of cases, symptoms were often due to rupture or expansion of the rupture of expansion of the aneurysms, with pressure on adjacent structures commonly causing genitourinary tract obstruction, thrombophlebitis, and/or lumbosacral nerve root compression. The overall incidence of rupture in 82 aneurysms was 38% (mortality, 56%). There was no correlation between aneurysm size and incidence of rupture. Eleven aneurysms were identified at autopsy or laparotomy; of the remaining 71 aneurysms, 15 were managed nonoperatively, with a mortality of 71% because of subsequent rupture. Proximal and distal ligation or endoaneurysmorrhaphy achieved the best results. Large blood losses commonly encountered with resection of the aneurysms contributed to a 55% mortality. Simple proximal ligation of the hypogastric artery aneurysm was followed by recurrence in two cases and in persistence of the aneurysmal mass in two other cases. Based on this analysis, surgical therapy for all isolated hypogastric aneurysms should be prompt.

Pain in the Back and Legs Caused by Cervical Spinal Cord Compression

Cervical spinal cord compression by tumor or degenerated disk material can cause low back and leg pains which simulate the lumbar disk syndrome. If the patient has roentgenographic evidence of both cervical and lumbar disk disease, the differential diagnosis can be difficult. The pain caused by cord compression tends to be diffuse, involves both legs, and is burning or aching in quality. Lumbosacral nerve root compression produces a sharp, radiating pain in the distribution of the involved root. The results of neurologic examination may be normal at a time when cord compression is sufficient to produce severe pain. The mechanical signs of lumbar disk herniation, limitation in back mobility, and a positive reaction to the straight leg raising test are absent with cord compression.