Nerve Roots In Patients Research Articles

Clinical Importance of Redundant Nerve Roots in Patients with Symptomatic Lumbar Spinal Stenosis: A Secondary Analysis of NORDSTEN Spinal Stenosis Trial Data.

Post-hoc analysis of data from a randomized clinical trial. To compare preoperative symptoms of patients with lumbar spinal stenosis (LSS) with and without redundant nerve roots (RNR), and to compare the change in clinical outcomes between those two groups 2 years after decompression surgery. RNR are often seen on MRI 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 radiological 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 LSS groups with (RNR+) and without RNR (RNR-) at baseline and after 2 years follow-up. Primary outcome was the mean change in the Oswestry Disability Score (ODI). Secondary outcomes included mean change in scores of the Zurich Claudication Questionnaire (ZCQ) and the numeric rating scale (NRS) for leg and back pain. 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, BMI 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 MRI. At 2-year follow-up the mean change of ODI was -22.1 in the RNR+ group and -17.4 in RNR- group (mean difference 4.7 (95%CI 1.3-8.2) P=0.007). Statistically significant differences were also found for secondary outcomes ZCQ, and NRS leg and back pain favouring the RNR+ group. Patients with RNR had similar baseline characteristics and similar symptoms as patients without. RNR before surgery were associated with better clinical improvement 2 years after decompression.

Effects of Multimodal Physical Therapy on Pain, Disability, H-reflex, and Diffusion Tensor Imaging Parameters in Patients With Lumbosacral Radiculopathy Due to Lumbar Disc Herniation: A Preliminary Trial.

Background Lumbosacral radiculopathy (LSR) due to lumbar disc herniation (LDH) is a condition caused by mechanical compression of nerve roots. Various physical therapy interventions have been proposed for the conservative management of LSR due to LDH. However, the study of physical therapy interventions in a multimodal form is lacking. Additionally, the effect of physical therapy on diffusion tensor imaging (DTI) parameters of the compressed nerve root has not been studied. This study aimed to investigate the effects of multimodal physical therapy (MPT) on pain, disability, soleus H-reflex, and DTI parameters of the compressed nerve root in patients with chronic unilateral LSR due to LDH. Methods A prospective preliminary pre-postclinical trial with a convenience sample was conducted. A total of 14 patients with chronic unilateral LSR due to paracentral L4-L5 or L5-S1 LDH were recruited for the study. Participants received a total of 18 sessions of a six-weekMPT program that consisted of electrophysical agents, manual therapy interventions, and core stability exercises. Electrophysical agents involved interferential current and hot pack. Manual therapy interventions included myofascial release, side posture positional distraction, passive spinal rotation mobilization, and high-velocity low-amplitude manipulation. Visual analog scale (VAS), Roland-Morris Disability Questionnaire (RMDQ), soleus H-reflex amplitude, side-to-side amplitude (H/H) ratio, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of the compressed nerve root were measured at baseline and post-intervention. Results There were significant improvements in VAS, RMDQ, H/H ratio, FA, and ADC of the compressed nerve root. Furthermore,significant improvement was found in the affected side compared with the contralateral side in H-reflex amplitude. Conclusions The observations of this preliminary trial suggest that MPT is a successful intervention in patients with chronic unilateral LSR due to LDH. Regarding DTI parameters of the compressed nerve root, FA increased and ADC decreased. Future studies with a control group, large sample sizes, and longer follow-up periods are needed.

Clinical significance of redundant nerve roots in patients with lumbar spinal stenosis undergoing oblique lumbar interbody fusion combined with percutaneous internal fixation

BackgroundWhile there have been previous studies on the surgical efficacy of patients with redundant nerve roots (RNRs), a persistent issue is that some patients continue to experience redundancy even after surgery. Furthermore, the clinical significance of RNRs remains unclear. Notably, there is a lack of research regarding RNRs within the context of oblique lumbar interbody fusion (OLIF) combined with percutaneous internal fixation. Therefore, the primary objective of this study is to investigate the correlation between RNRs and clinical outcomes following OLIF combined with percutaneous internal fixation.MethodsEighty-seven patients diagnosed with lumbar spinal stenosis (LSS) who underwent single-segment OLIF combined with percutaneous internal fixation were categorized into three groups. Group 1 comprised patients with positive RNRs both before and after the operation. Group 2 included patients with positive RNRs preoperatively but negative RNRs postoperatively. Group 3 consisted of patients with consistently negative RNRs before and after the operation. Comprehensive patient data were collected, including operation time, intraoperative blood loss, and any recorded complications. Radiographic parameters, both pre- and post-operative, were assessed, encompassing the number of stenosis segments, disc height (DH), lumbar lordotic angle, dural sac cross-sectional area, and the placement of the fusion cage. Furthermore, the Visual Analogue Scale was applied to gauge back and leg pain, while the Oswestry Disability Index was employed to appraise daily living activities. A comparative analysis was carried out among the three patient groups.ResultsIn this study, all 87 LSS patients successfully underwent surgery. Among them, 35 patients (40.2%) showed preoperative MRI assessment indicating positive RNRs. In the postoperative MRI assessment, 14 of these patients maintained positive RNRs status, and they were grouped into Group 1. The remaining 21 patients saw a transition to negative RNRs status and were included in Group 2. Among the 52 patients who had preoperative MRI assessments showing negative RNRs, their postoperative RNRs status remained negative, forming Group 3. All patients received follow-up, which ranged from 8 to 18 months, and no complications occurred during this period. In this study, the postoperative efficacy and parameters such as DH and Dural Sac CSA significantly improved compared to preoperative values for all 87 patients. Patients with preoperative RNRs had more stenosis segments, smaller dural sac CSA, and more severe symptoms. In all three groups, postoperative efficacy scores significantly improved compared to preoperative scores. Group 2 patients had their fusion cages placed more in the middle, while Group 1 patients had their fusion cages more anteriorly located. Group 2 patients exhibited greater recovery in dural sac CSA postoperatively compared to Group 1 patients. Additionally, Group 2 patients had better ODI efficacy scores compared to Group 1 patients.ConclusionsIrrespective of the presence or absence of RNRs, patients experienced improvement after undergoing OLIF combined with percutaneous internal fixation. Preoperative RNRs appear to be linked to multi-segmental lumbar spinal stenosis, a reduction in dural sac CSA, and symptom severity. Patients with negative postoperative RNRs demonstrated better treatment efficacy. Furthermore, the placement of the fusion cage appears to have a significant impact on postoperative efficacy and RNRs outcomes.

Clinical significance and risk factors of redundant nerve root in patients with lumbar spinal stenosis

To investigate the clinical significance and screen the risk factors of redundant nerve roots(RNRs) in patients with lumbar spinal stenosis. The clinical data of 196 patients with lumbar spinal stenosis in the department of Spinal Surgery, Yijishan Hospital, Wannan Medical College from April 1, 2015 to November 30, 2020 were retrospectively analyzed. All patients were divided into RNRs positive group and RNRs negative group according to the presence of RNRs. The differences in general clinical data, imaging parameters, visual analogue scale(VAS), Oswestry disability index(ODI), and other indicators between the two groups were compared. The risk factors which are highly correlated with RNRs were screened by binary Logistic regression analysis. There were 59 cases in the RNRs positive group, with an occurrence rate of 29.95% (59/137), and 137 cases in the RNRs negative group. The incidence rate of RNRs in 196 patients with lumbar spinal stenosis was 30.10% (59/196). VAS and ODI scores of patients in the two groups were statistically significant (P<0.05), and clinical symptoms of patients in the RNRs positive group were more severe than those in the RNRs negative group. There were significant differences in age, number of stenosis segments, average area of lumbar dural sac, area of the narrowest segment and the narrowest segment(P<0.05). Binary logistic regression analysis showed that the number of stenosis segments, the average median sagittal diameter of spinal canal, and the average area of dural sac in lumbar intervertebral space were correlated with the generation of RNRs (P<0.05). The regression coefficient of the number of stenosis segments was -1.115, the regression coefficient of the median sagittal diameter of the spinal canal was -1.707, and the regression coefficient of the mean dural sac area of the lumbar intervertebral space was 7.556. The clinical symptoms of patients with lumbar spinal stenosis accompanied by RNRs are more severe than those without them. The number of narrow segments, median sagittal diameter of the spinal canal, and the area of the lumbar intervertebral dural sac are the high-risk factors for RNRs, with the area of the lumbar intervertebral dural sac has the highest correlation.

Assessment of Lumbosacral Nerve Roots in Patients with Type 2 Diabetic Peripheral Neuropathy Using Diffusion Tensor Imaging.

Diffusion tensor imaging (DTI) has found clinical applications in the evaluation of the central nervous system and has been extensively used to image peripheral neuropathy. However, few studies have focused on lumbosacral nerve root fiber damage in diabetic peripheral neuropathy (DPN). The aim of the study was to evaluate whether DTI of the lumbosacral nerve roots can be used to detect DPN. Thirty-two type 2 diabetic patients with DPN and thirty healthy controls (HCs) were investigated with a 3T MRI scanner. DTI with tractography of the L4, L5, and S1 nerve roots was performed. Anatomical fusion with the axial T2 sequences was used to provide correlating anatomical information. Mean fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were measured from tractography images and compared between groups. Diagnostic value was assessed using receiver operating characteristic (ROC) analysis. The Pearson correlation coefficient was used to explore the correlation between DTI parameters and clinical data and the nerve conduction study (NCS) in the DPN group. In the DPN group, FA was decreased (p < 0.001) and ADC was increased (p < 0.001) compared with the values of the HC group. FA displayed the best diagnostic accuracy, with an area under the ROC curve of 0.716. ADC was positively correlated with HbA1c level (r = 0.379, p = 0.024) in the DPN group. DTI of lumbosacral nerve roots demonstrates appreciable diagnostic accuracy in patients with DPN.

MRI negative Varicella zoster virus (VZV) plexopathy in a young man with history of malignancy (P2-4.001)

<h3>Objective:</h3> To emphasize the importance of including VZV plexopathy in differential diagnosis in young individuals and to prevent the delay in diagnosis and treatment <h3>Background:</h3> VZV-associated plexopathy in mainly patients over 60 years old. Post herpetic neuralgia is a well-known complication of Herpes Zoster (HZ), however segmental zoster paresis secondary to HZ was reported in 1–20% of the cases in literature. MRI findings may be positive in up to 70% of the patients. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> 43 years-old man with history of grade 2 left frontal oligodendroglioma which was treated with 2 partial resections, radiation and adjuvant procarbazine/lomustine presented with left upper extremity pain and developed a blistering rash in dermatomal pattern in left proximal upper extremity 2 weeks after the initial symptoms. He was diagnosed with shingles and treated with steroids and acyclovir with minimal improvement. 6 weeks after presentation, physical exam revealed left deltoid, supraspinatus and infraspinatus weakness with normal muscle stretch reflexes and decreased sensation on C5 dermatome. EMG revealed absent left lateral antebrachial cutaneous sensory nerve action potentials (SNAP) amplitude, and a small left radial SNAP amplitude compared to the right side. Evidence of ongoing denervation with reinnervation was seen in the left upper trunk supplied muscles. MRI of the brachial plexus was negative for any abnormalities. Patient was diagnosed with VZV-associated plexopathy, improved with pregabalin and physical therapy. <h3>Conclusions:</h3> Our patient was significantly younger than expected in HZ group. MRI usually shows T2 hyperintensities and thickening of the nerve roots in patients with VZV-associated plexopathy. However, the presentation, onset of symptoms, characteristics of the rash and clinical course was diagnostic of HZ, and the weakness pattern, supported by the EMG findings were diagnostic for VZV-associated plexopathy. <b>Disclosure:</b> Dr. Gul has nothing to disclose. Ms. Ahmed has nothing to disclose. Dr. McGraw has nothing to disclose. Dr. Alshiekh Nasany has nothing to disclose.

Effectiveness of caudal block in patients with spinal stenosis accompanied by redundant nerve root syndrome

Redundant nerve root syndrome (RNRS) is characterized by tortuous, elongated, and enlarged nerve roots in patients with lumbar spinal stenosis. This study was performed to evaluate the effects of caudal block in patients with RNRS and assess factors associated with RNRS. Patients with lumbar spinal stenosis who underwent caudal block were retrospectively analyzed. A comparative analysis of pain reduction was conducted between patients with RNRS (Group R) and those without RNRS (Group C). Generalized estimating equation analysis was used to identify factors related to the treatment response. RNRS-associated factors were analyzed using logistic regression analysis. In total, 54 patients were enrolled (Group R, n = 22; Group C, n = 32). Group R had older patients than Group C. The caudal block showed less pain reduction in Group R than in Group C, but the difference was not statistically significant. Generalized estimating equation analysis showed that RNRS was the factor significantly associated with the treatment response. The dural sac anteroposterior diameter and left ligamentum flavum thickness were associated with RNRS in the logistic regression analysis. Caudal block tended to be less effective in patients with than without RNRS, but the difference was not statistically significant.

Diagnostic value of curved planar reformation of MRI for lumbosacral nerve roots in the localization of nerve roots for adult lumbar degenerative scoliosis.

To compare the diagnostic value of curved planar reformation of MRI (MRI-CPR) and 2D MRI in determining the responsible nerve in patients with adult lumbar degenerative scoliosis (ALDS). A total of 45 patients diagnosed with ALDS were included in the study. All patients underwent MRI-CPR and 2D MRI and subsequently received surgery. These two diagnostic methods were compared with the results of surgical exploration to assess nerve root compression. The sensitivity and accuracy of MRI-CPR are higher than 2D MRI (93.8% vs 80.0%; 92.8% vs 77.7%, respectively). And the specificity of MRI-CPR is higher than 2D MRI (87.5% vs 68.8%). Besides, the PPV and NPV of MRI-CPR are higher than 2D MRI (96.8% vs 91.2%; 7.8.% vs 45.8%). The area (AUC) under the receiver operating characteristic curve (ROC) for MRI-CPR and 2D MRI was 0.74 and 0.91, respectively. The judgement was made by two independent radiologists, while the consistency tests for 2D MRI and MRI-CPR with Kappa values were 90.6% and 82.2%, respectively. The clinical diagnostic value of MRI-CPR was better than 2D MRI in the determination of the responsible nerve root. Moreover, MRI-CPR sequence images can clearly show the route of lumbosacral nerve roots and their relationship with adjacent tissues. Therefore, MRI-CPR can be an important complement to conventional 2D MRI in the diagnosis of responsible nerve roots in patients with ALDS.

Prevalence of Electrodiagnostic Lumbosacral Nerve Root Involvement in Patients Presenting with Radicular Low Back Pain Referred to Physical Medicine and Rehabilitation Clinic

Background: Low back pain is one of the most common causes of clinic referrals. In most patients, radicular pain results from the compression or injury of the proximal nerve root or dorsal root ganglion. Objectives: This study aimed to investigate the electrodiagnostic involvement of lumbar nerve roots in patients with lumbar radicular pain undergoing electromyography (EMG) and nerve conduction study. Methods: The sample population was selected from 18-70-year-old patients who had files in the clinic, complaining of lumbar pain radiating to the lower extremities for at least 2 months. Patient data were extracted from the available data and recorded in a separate anonymous information sheet. Results: This study was carried out on 352 patients with lumbar radicular pain. In addition to radicular pain, paresthesia was present in 86 patients (24.4%). Out of 352 patients with radicular pain, 294 cases (83.52%) showed unilateral or bilateral involvement in EMG. Among those who had paresthesia, 74 patients (86%) showed nerve root involvement in EMG. Conclusions: This study indicated the compatibility between lumbar radicular pain symptoms and the features observed in EMG, particularly in areas of paresthesia or the side of pain. Therefore, the patient’s symptoms can help predict nerve root involvement in the electrodiagnostic study before conducting this test.

Radiological evaluation and clinical importance of redundant nerve roots in patients with symptomatic lumbar spinal stenosis - Secondary analysis of a randomized trial

Radiological evaluation and clinical importance of redundant nerve roots in patients with symptomatic lumbar spinal stenosis - Secondary analysis of a randomized trial

Clinical Outcomes of Interlaminar Percutaneous Endoscopic Uniportal Pars Decompression for Lumbar Spondylolysis.

To evaluate the clinical and radiological outcomes of a novel full endoscopic procedure performed via an interlaminar approach to decompress entrapped nerve roots in patients with lumbar spondylolysis. Patients who underwent interlaminar percutaneous endoscopic pars decompression were included in this retrospective cohort study. Patients with back pain and dynamic lumbar instability were excluded from the study. Clinical parameters related to outcomes, including the Oswestry Disability Index (ODI) and visual analog scale (VAS) for leg pain, were assessed before and after surgery. The radiological outcomes, vertebral slippage percentage, and motion radiographs were evaluated preoperatively and postoperatively. Of the 11 patients included in the study, 5 had spondylolysis alone, 1 of whom had spondylolysis at L3-L4 and L4-L5, and 4 of whom had it at L5-S1; and 6 patients had spondylolysis in combination with spondylolisthesis, of whom 4 had involvement at L5-S1, 1 had involvement at L4-L5, and 1 had involvement at L3-L4. At a mean follow-up period of 22.64 months, 63.3% of patients achieved more than 50% improvement in ODI score and 90.91% of patients achieved more than 50% improvement in VAS score. Spondylolysis with vertebral slippage had inferior ODI improvement outcomes as compared with spondylolysis alone, but the VAS was not significantly different. No significant difference was observed on the slippage percentage observed between the pre- and postoperative periods. However, 1 patient experienced vertebral slippage after surgery, but fusion surgery was not required. Interlaminar percutaneous endoscopic pars decompression is a safe and successful treatment for patients with stable lumbar spondylolysis and nerve root compression. Even in situations in which vertebral slippage occurs, spinal fusion may not be the best option for all patients with lumbar spondylolysis. The interlaminar percutaneous endoscopic pars decompression is a safe and successful procedure for treatment of patients with stable lumbar spondylolysis and nerve root compression.

Patients having surgery for ulnar nerve compression at the elbow rarely have affection of the spinal nerve root at C8-Th1 levels.

Cervical pathology may contribute to residual problems after surgery for ulnar nerve compression. We aimed to evaluate the presence of pathological conditions in spinal cord and cervical spinal nerve roots in patients surgically treated for ulnar nerve compression at elbow. In a cohort of patients, surgically treated for ulnar nerve compression at elbow, magnetic resonance images (MRI; performed 3 years pre/postoperatively) were evaluated by a neuroradiologist blinded to patient characteristics and outcome of surgery. Cervical conditions were assessed and related to patient characteristics, preoperative McGowan grade, and outcome. Among 62 patients (45 unilaterally and 17 bilaterally), only one had spinal nerve root affection of nerve roots contributing to the ulnar nerve (C8-Th1). About half of the patients, mainly those at higher age, had alterations affecting C3-C7 spinal nerve roots at both surgically treated and contralateral, non-surgically treated, sides. Only few other changes were observed at cervical levels. A high McGowan grading was related to a high frequency of spinal nerve root affection. Smokers were more frequently observed among those with spinal nerve root affection at C3-C7 levels at surgically treated side. Residual problems, expressed as patient dissatisfaction and DASH score ≥40, were common. Spinal nerve roots, contributing to the ulnar nerve, are rarely affected in surgically treated patients with ulnar nerve compression at elbow even though pathology is often observed at other cervical levels. Pathology is often detected at other cervical spinal nerve root levels at surgically treated and contralateral sides, particularly among older patients, smokers, and in conjunction with worse preoperative McGowan grade. No relation between cervical pathology and outcome of ulnar nerve surgery is seen.

Segmental muscle innervation as a basic anatomophysiological knowledge for diagnostic procedure of neuromuscular disorders and thus, a way for accurate EMG diagnosis of single root injury. Retrospective study in patients with radicular symptoms

Background: An accurate identification of the injured nerve roots by EMG in patients with symptomatic CSD requires that the examined muscles are innervated by a single nerve root. In the present retrospective study, the authors address the question of whether such innervation of chosen muscles in the upper extremity can be identified. Methods: Scored EMG results of chosen muscles with the hypothesized innervation by C6, C7 or C8 nerve roots, collected from 42 patients, were compiled as single EMG variables and compared with the respective MRI data, possibly responsible for injury of those roots, using Spearman’s rho (SRC) analysis. Subsequently, each EMG variable was adopted as specific diagnostic method for single root injury and tested for its specificity and then sensitivity in relation to the data of the highest ranked MRI, used as a ‘gold standard method’ Results: SRC results showed positive rank correlation, with the highest p-values, between EMG and the respective MRI variables, in 64 included extremities. Consequently, the assumed EMG-C6, -C7 and -C8 methods showed a high specificity (97% - 100%) against the respective highest ranked MRI. The relative sensitivity of the EMG methods calculated in this way were 38% for the C6-root, 87% for the C7 and 50% for the C8. Conclusions: The results corroborate the presumed innervation of the chosens muscles by single C6, C7, or C8 nerve root, thus allowing the use of needle EMG examination of those muscles for accurate identification of injured single nerve roots in patients with symptomatic CSD.

Changes and clinical correlation of diffusion tensor imaging parameters of compressed spinal cord and nerve root in patients with cervical spondylosis

BackgroundDiffusion tensor imaging (DTI) was used to quantitatively study the characteristics of the related spinal cord and nerve root compression parameters in patients with cervical spondylosis (CS), and diffusion tensor tractography (DTT) was used to visualize the spinal cord and nerve root and analyze their relevance to clinical evaluation.MethodsA total of 67 patients with CS and 30 healthy volunteers received 3.0 T magnetic resonance imaging. Cervical DTI and DTT were performed in all the participants, where the b value of DTI was set at 800 s/mm2. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the spinal cord and cervical nerve roots were measured by using DTI. Patients with CS were scored according to the modified Japanese Orthopedic Association (mJOA) score.ResultsIn all the participants, the spinal cord and cervical nerve roots were clearly visible by DTT. Compared to the healthy volunteers, the FA values were significantly decreased and ADC values were significantly increased in patients with CS. mJOA score was significantly correlated with the DTI index (ADC and FA) values. Receiver operator characteristic curve analysis revealed that FA and ADC could identify mild, moderate, and severe CS.ConclusionsDTI parameters of cervical spinal cord and nerve root compression are associated with the clinical evaluation of patients with CS and may be helpful in assessing the severity of CS.

Clinical Significance of Redundant Nerve Roots in Patients with Lumbar Stenosis Undergoing Minimally Invasive Tubular Decompression

Symptomatic lumbar spinal stenosis (LSS) is a common indication for surgery in the elderly. Preoperative radiographic evaluation of patients with LSS often reveals redundant nerve roots (RNRs). The clinical significance of RNRs is uncertain. RNRs have not been studied in the setting of minimally invasive surgery. This study investigates the relationship between RNRs and clinical outcomes after minimally invasive tubular decompression. Chart review was performed for patients with degenerative LSS who underwent minimally invasive decompression. Preoperative magnetic resonance imaging parameters were assessed, and patient-reported outcomes were analyzed. Fifty-four patients underwent surgery performed at an average of 1.8±0.8 spinal levels. Thirty-one patients (57%) had RNRs. Patients with RNRs were older (median= 72years vs. 66years, P=0.050), had longer median symptom duration (32months vs. 15months, P<0.01), and had more levels operated on (2.1 vs. 1.4; P<0.01). The median follow-up after surgery was 2months (range= 1.3-12months). Preoperative and postoperative patient-reported outcomes were similar based on RNR presence. Patients without RNRs had larger lumbar cross-sectional areas (CSAs) (median= 121mm2 vs. 95mm2, P=0.014) and the index-level CSA (52mm2 vs. 34mm2, P=0.007). The CSA was not correlated with RNR morphology or location. Preoperative RNRs are associated with increased age, symptom duration, and lumbar stenosis severity. Patients improved after minimally invasive decompression regardless of RNR presence. RNR presence had no effect on short-term clinical outcomes. Further study is required to assess their long-term significance.

MRI of the intraspinal nerve roots in patients with chronic inflammatory neuropathies: abnormalities correlate with clinical phenotypes.

Chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) are caused by inflammatory changes of peripheral nerves. It is unknown if the intra-spinal roots are also affected. This MRI study systematically visualized intra-spinal nerve roots, i.e., the ventral and dorsal roots, in patients with CIDP, MMN and motor neuron disease (MND). We performed a cross-sectional study in 40 patients with CIDP, 27 with MMN and 34 with MND. All patients underwent an MRI scan of the cervical intra-spinal roots. We systematically measured intra-spinal nerve root sizes bilaterally in the transversal plane at C5, C6 and C7 level. We calculated mean nerve root sizes and compared them between study groups and between different clinical phenotypes using a univariate general linear model. Patients with MMN and CIDP with a motor phenotype had thicker ventral roots compared to patients with CIDP with a sensorimotor phenotype (p = 0.012), while patients with CIDP with a sensory phenotype had thicker dorsal roots compared to patients with a sensorimotor phenotype (p = 0.001) and with MND (p = 0.004). We here show changes in the morphology of intra-spinal nerve roots in patients with chronic inflammatory neuropathies, compatible with their clinical phenotype.

Microstructural Alteration of Lumbosacral Nerve Roots in Chronic Inflammatory Demyelinating Polyradiculoneuropathy: Insights From DTI and Correlations with Electrophysiological Parameters

To detect the diffusion characteristics of lumbosacral nerve roots in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and further to explore their correlations with electrophysiological parameters of lower extremity nerves. Eighteen CIDP patients and 18 age and sex-matched healthy volunteers were enrolled in this study from August 2019 to August 2020. Axial diffusion tensor imaging (DTI) of lumbosacral plexus was performed in all subjects and fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD) of lumbosacral nerve roots were measured. Two-sample t test or Mann-Whitney U test was used to compare the difference of DTI parameters between two groups. Receiver operating characteristic curves were plotted to determine the diagnostic accuracy. All patients also underwent nerve conduction studies. Correlations between DTI parameters of lumbosacral nerve roots and electrophysiological parameters were analyzed with Pearson or Spearman coefficients. CIDP patients showed significantly lower FA as well as higher AD, RD, and MD values of lumbosacral nerve roots (FA:0.24±0.054, 0.32±0.044; AD:2.31±0.256, 2.11±0.230 (×10-3mm2/s); RD:1.28±0.189, 1.13±0.106 (×10-3mm2/s); MD:1.68±0.268, 1.45±0.186 (×10-3mm2/s) in CIDP and control group, respectively, all p < 0.05). Receiver operating characteristic analysis showed among all DTI parameters, FA had the best diagnostic accuracy with an area under the curve of 0.914 and optimal cut-off value of 0.27. FA showed a positive correlation while RD showed a negative correlation with a conduction velocity of tibial and common peroneal nerves. RD also correlated positively with F-wave minimal latency of tibial nerves. DTI can be used to assess the microstructure alterations of lumbosacral nerve roots in CIDP patients. FA and RD may serve as potential markers reflecting the conduction function of tibial and common peroneal nerves.

Efficacy of gelatin sponge impregnated with ropivacaine on postoperative pain after transforaminal lumbar interbody fusion: a comparative study

BackgroundThe purpose of this study was to investigate the efficacy of gelatin sponge impregnated with ropivacaine on postoperative pain after transforaminal lumbar interbody fusion (TLIF) in patients with lumbar degenerative diseases.MethodsWe retrospectively reviewed patients who underwent TLIF in our department between August 2018 and January 2020. Patients were divided to ropivacaine group and saline group. A ropivacaine group whom received gelatin sponge impregnated with ropivacaine during operation, and a saline group whom were intraoperatively administered by gelatin sponge impregnated with saline. The two groups were compared in reference to postoperative hospital stay, postoperative complications and visual analog scale (VAS) scores. The consumption of postoperative diclofenac sodium suppository use was also recorded. The Oswestry Disability Index (ODI) scores and Japanese Orthopedic Association (JOA) scores were used for functional evaluation at 1 year postoperatively.ResultA total of 127 patients were evaluated in this retrospective study. The mean postoperative hospital stay in the ropivacaine group was significantly lower than saline group. The VAS score was significantly lower in patients receiving gelatin sponge impregnated with ropivacaine as compared with patients in saline group on postoperative day 1, 2, 3 and 4. The number of patients who need the administration of diclofenac sodium suppository and the mean consumption of postoperative diclofenac sodium suppository was significantly lower in the ropivacaine group as compared with saline group.ConclusionThe application of gelatin sponge impregnated with ropivacaine around the nerve root in patients undergoing TLIF can effectively control the postoperative pain and reduce postoperative hospital stay.

Fast Independent Component Analysis Algorithm-Based Diagnosis of L5 Nerve Root Compression and Changes of Brain Functional Areas Using 3D Functional Magnetic Resonance Imaging.

In this paper, the application of 3-dimensional (3D) functional magnetic resonance imaging (FMRI) in the diagnosis of the 5th lumbar (L5) nerve root compression and brain functional areas in patients with lumbar disc herniation (LDH) was analyzed. The traditional fast independent component analysis (Fast ICA) algorithm was optimized based on the modified whitening matrix to establish a new type of Modified-Fast ICA (M-Fast ICA) algorithm that was compared with the introduced traditional Fast ICA and ICA. M-Fast ICA was applied to the 3D FMRI diffusion tensor imaging (DTI) evaluation of 65 patients with L5 nerve root pain due to LDH (group A) and 50 healthy volunteers (group B). The values of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in the lumbar nerve roots (L3, L4, L5, and the 1st sacral vertebra (S1)) were recorded among subjects from the two groups. Besides, the score of edema degree in the lumbar nerve roots (L5 and S1) and activity of brain functional areas were also recorded among all subjects of the two groups. The results showed that the mean square error of M-Fast ICA was smaller than that of traditional Fast ICA and ICA, while its signal-to-noise ratio (SNR) was greater than that of Fast ICA and ICA (P < 0.05). The FA of L5 and S1 nerve roots in patients of group A was sharply lower than the values of group B, while the ADC of patients in group A was greater than that of the control group (P < 0.05). Besides, the score of edema in L5 and S1 nerve roots of patients in group A increased in contrast to group B (P < 0.05). The brain areas were activated after surgery including bilateral temporal lobe, left thalamus, splenium of corpus callosum, and right internal capsule. In conclusion, the 3D image denoising performance of M-Fast ICA optimized and constructed in this study was superior to that of the traditional Fast ICA and ICA. The FA of patients with L5 nerve root pain due to LDH decreased steeply, while the ADC increased dramatically. L5 nerve root pain caused by LDH resulted in changes in brain functional areas of the patients to inhibit the resting state default network activity, and the corresponding brain functional areas could be activated through treatment.

SY3.3. Role of ultrasound in ALS

Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disorder defined through the involvement of upper and lower motor neuronal systems. The clinical and neurophysiological investigation remains the gold standard in the diagnosis of ALS due to the lack of a definitive biomarker. Recently, a high-resolution ultrasound technique has been developed and is becoming popular in the field of the diagnosis of neuromuscular diseases. Also in the diagnosis and monitoring of ALS, neuromuscular ultrasound provides complementary information to clinical assessment and neurophysiological testing as well as insights into the underlying pathophysiology of this disease. Muscle ultrasound is used for detecting widespread fasciculations and assessing muscle atrophy. Dynamic diaphragm thickness change can be measured by ultrasound and its change correlates with respiratory function. Bulbar muscle ultrasound is also useful for the assessment of bulbar dysfunction and dysphagia. Nerve ultrasound can detect a reduction in cross-sectional area (CSA) and diameter of peripheral nerves and nerve roots in patients with ALS, reflecting nerve atrophy due to motor nerve axonal loss. These findings help us to distinguish ALS from mimicking diseases such as multifocal motor neuropathy, in which increased nerve size is observed. In addition, nerve CSA has a correlation with CSF level of progranulin which increases to maintain structure and function of neurons. Ultrasound examination is an operator-dependent and machine-dependent. However, the neuromuscular ultrasound technique is easy to learn. To have a skill of neuromuscular ultrasound is valuable to diagnose ALS accurately and to understand the pathophysiology of ALS deeper.