title: Post-surgical functional recovery, lumbar lordosis, and range of motion associated with MR-detectable redundant nerve roots in lumbar spinal stenosis.
abstract: OBJECTIVE
  T1- and T2-weighted magnetic resonance images (MRI) can reveal lumbar redundant nerve roots (RNRs), a result of chronic compression and nerve elongation associated with pathogenesis of cauda equina claudication (CEC) in degenerative lumbar canal stenosis (DLCS). The study investigated effects of lumbar lordosis angle and range of motion on functional recovery in lumbar stenosis patents with and without RNRs.
  
  
  METHODS
  A retrospective study was conducted of 93 lumbar spinal stenosis patients who underwent decompressive surgery. Eligible records were assessed by 3 independent blinded radiologists for presence or absence of RNRs on sagittal T2-weighted MR (RNR and non-RNR groups), pre- and post-operative JOA score, lumbar lordosis angle, and range of motion.
  
  
  RESULTS
  Of 93 total patients, the RNR group (n=37, 21/37 female) and non-RNR group (n=56; 31/56 female) had similar preoperative conditions (JOA score) and were not significantly different in age (mean 64.19 ± 8.25 vs. 62.8 ± 9.41 years), symptom duration (30.92 ± 22.43 vs. 28.64 ± 17.40 months), or follow-up periods (17.35 ± 4.02 vs. 17.75 ± 4.29 mo) (all p>0.4). The non-RNR group exhibited significantly better final JOA score (p=0.015) and recovery rate (p=0.002). RNR group patients exhibited larger lumbar lordosis angles in the neutral position (p=0.009) and extension (p=0.021) and larger range of motion (p=0.008).
  
  
  CONCLUSIONS
  Poorer surgical outcomes in patients with RNRs indicated that elevated lumbar lordosis angle and range of motion increased risks of RNR formation, which in turn may cause poorer post-surgical recovery, this information is possibly useful in prognostic assessment of lumbar stenosis complicated by RNRs.
authors.affiliation: Department of Orthopedics, Fuzhou General Hospital, Nanjing Military Command, Fuzhou 350025, PR China.
authors.forename: Jinshui
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Nephrology, Fuzhou General Hospital, Nanjing Military Command, Fuzhou 350025, PR China.
authors.forename: Juying
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Fuzhou General Hospital, Nanjing Military Command, Fuzhou 350025, PR China.
authors.forename: Benhai
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Fuzhou General Hospital, Nanjing Military Command, Fuzhou 350025, PR China. Electronic address: xuhao20150617@sina.com.
authors.forename: Hao
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Orthopedics, Fuzhou General Hospital, Nanjing Military Command, Fuzhou 350025, PR China. Electronic address: linsongqing1966@163.com.
authors.forename: Songqing
authors.initials: S
authors.lastname: Lin
authors.affiliation: Department of Orthopedics, Fuzhou General Hospital, Nanjing Military Command, Fuzhou 350025, PR China.
authors.forename: Huihao
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002420:Cauda Equina / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008141:Lordosis / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D013126:Spinal Nerve Roots / Q000601:surgery*; D013130:Spinal Stenosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cauda equina claudication; Lumbar lordosis; Lumbar spinal stenosis; Range of motion; Redundant nerve roots