Effectiveness of lumbar epidural injection in patients with chronic spinal stenosis accompanying redundant nerve roots

Abstract

Redundant nerve root syndrome (RNRS) is a phenomenon characterized by the presence of elongated, enlarged, tortuous nerve roots in the lumbar subarachnoid space. It is unclear whether RNRS is caused by spinal stenosis or causes these symptoms.This study evaluated the effects of lumbar epidural steroid injection (LESI) on patients with RNRS and assessed factors associated with RNRS. This retrospective observational cohort study was conducted at a single pain clinic of a university hospital.The medical records of 172 outpatients presenting with low back and/or leg pain from July to December 2014 were analyzed. Pain intensity (numeric rating scale [NRS]) and functional status were assessed at baseline and 2, 4, and 12 weeks after the LESI. Patients were considered moderate responders if they showed a 3-point or >30% reduction in baseline NRS, or said "better than 30%," "a little better," or "I feel an effect." Patients were considered substantial responders if they showed a 5-point or >50% reduction in baseline NRS, or said "better than 50%," "very good," or "much better." Generalized estimating equation (GEE) analysis was performed to identify the factors associated with moderate response to LESI. Factors associated with RNRS were also determined by logistic regression analysis.The proportions of both moderate and substantial responders at 2, 4, and 12 weeks were significantly lower in patients with than without RNRS. GEE analysis showed that RNRS were the only factor significantly associated with moderate response to LESI (OR = 0.400; 95% CI, 0.253-0.632; P < .001). The distance from the conus medullaris to the closest level of stenosis was shorter in patients with than without RNRS (P < .001) and was the only independent factor associated with RNRS on multivariate logistic regression analysis (OR = 0.972; P < .001).LESI was less effective in patients with than without RNRS. The only independent factor significantly associated with RNRS was the distance from the conus medullaris to the nearest moderate stenosis.

Figure 1

Lumbar magnetic resonance image of redundant nerve root syndrome (RNRS). Both axial (A) and sagittal views (B) show tortuosity and redundancy of nerve roots.

Figure 2

Study flow diagram.

Figure 3

Proportions of (A) moderate and substantial responders and (B) substantial responders alone among patients with (group R) and without (group C) redundant nerve root syndrome (RNRS). The percentages of responders to lumbar epidural steroid injection were significantly lower in patients with than without RNRS at 2 weeks, 1 month, and 3 months. None of the patients in group R had a significant response at 3 months.