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Levi R, Battaglia M, Garoli F, Cappellini LA, De Robertis M, Anselmi L, Savini G, Riva M, Fornari M, Grimaldi M, Politi LS. Quantification of cauda equina nerve root dispersion through radiomics features in weight-bearing MRI in normal subjects and spinal canal stenosis patients. Eur Radiol 2024; 34:4585-4595. [PMID: 38057593 DOI: 10.1007/s00330-023-10467-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To quantify the distribution of cauda equina nerve roots in supine and upright positions using manual measurements and radiomics features both in normal subjects and in lumbar spinal canal stenosis (LSCS) patients. METHODS We retrospectively recruited patients who underwent weight-bearing MRI in supine and upright positions for back pain. 3D T2-weighted isotropic acquisition (3D-HYCE) sequences were used to develop a 3D convolutional neural network for identification and segmentation of lumbar vertebrae. Para-axial reformatted images perpendicular to the spinal canal and parallel to each vertebral endplate were automatically extracted. From each level, we computed the maximum antero-posterior (AP) and latero-lateral (LL) dispersion of nerve roots; further, radiomics features were extracted to quantify standardized metrics of nerve root distribution. RESULTS We included 16 patients with LSCS and 20 normal subjects. In normal subjects, nerve root AP dispersion significantly increased from supine to upright position (p < 0.001, L2-L5 levels), and radiomics features showed an increase in non-uniformity. In LSCS subjects, in the upright position AP dispersion of nerve roots and entropy-related features increased caudally to the stenosis level (p < 0.001) and decreased cranially (p < 0.001). Moreover, entropy-related radiomics features negatively correlated with pre-operative Pain Numerical Rating Scale. Comparison between normal subjects and LSCS patients showed a difference in AP dispersion and increase of variance cranially to the stenosis level (p < 0.001) in the upright position. CONCLUSIONS Nerve root distribution inside the dural sac changed between supine and upright positions, and radiomics features were able to quantify the differences between normal and LSCS subjects. CLINICAL RELEVANCE STATEMENT The distribution of cauda equina nerve roots and the redundant nerve root sign significantly varies between supine and upright positions in normal subjects and spinal canal stenosis patients, respectively. Radiomics features quantify nerve root dispersion and correlates with pain severity. KEY POINTS • Weight-bearing MRI depicts spatial distribution of the cauda equina in both supine and upright positions in normal subjects and spinal stenosis patients. • Radiomics features can quantify the effects of spinal stenosis on the dispersion of the cauda equina in the dural sac. • In the orthostatic position, dispersion of nerve roots is different in lumbar spinal stenosis patients compared to that in normal subjects; entropy-related features negatively correlated with pre-operative Pain Numerical Rating Scale.
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Affiliation(s)
- Riccardo Levi
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy
- Department of Neuroradiology, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - Massimiliano Battaglia
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy
- Department of Neuroradiology, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - Federico Garoli
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy
- Department of Neuroradiology, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - Luca Alessandro Cappellini
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy
- Department of Neuroradiology, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - Mario De Robertis
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - Leonardo Anselmi
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - Giovanni Savini
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy
- Department of Neuroradiology, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - Marco Riva
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - Maurizio Fornari
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - Marco Grimaldi
- Department of Neuroradiology, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - Letterio S Politi
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy.
- Department of Neuroradiology, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy.
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
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Victorio, Shen R, Nasution MN, Mahadewa TGB. Full endoscopic percutaneous stenoscopic lumbar decompression and discectomy: An outcome and efficacy analysis on 606 lumbar stenosis patients. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:247-253. [PMID: 38957755 PMCID: PMC11216654 DOI: 10.4103/jcvjs.jcvjs_48_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 04/09/2024] [Indexed: 07/04/2024] Open
Abstract
Introduction Laminectomy has long been a "gold standard" to treat symptomatic lumbar spinal stenosis (LSS). Minimal invasive spine surgery (MISS) is widely developed to overcome the limitations of conventional laminectomy to achieve a better outcome with minimal complications. Full endoscopic percutaneous stenoscopic lumbar decompression (FE-PSLD) is the newest MISS technique for spinal canal decompression. We aimed to evaluate and analyze the significance of FE-PSLD in reducing pain and its association with age, duration of symptoms, stenosis level, and operative time (OT). Materials and Methods A longitudinal cross-sectional study was conducted on 606 LSS patients who underwent FE-PSLD and enrolled from 2020 to 2022. Three-month evaluation of the Visual Analog Scale (VAS) and the modified MacNab criteria were assessed. The significance of changes was analyzed using the Wilcoxon signed-ranks test. Spearman's correlation test was performed to evaluate the significant correlation of several variables (pre-PSLD-VAS, age, symptoms duration, OT, and level of LSS) to post-PSLD-VAS, and multiple regression analysis was conducted. Results The reduction of VAS was statistically significant (P ≤ 0.005) with an average pre-PSLD-VAS of 6.75 ± 0.63 and post-PSLD-VAS of 2.24 ± 1.04. Pre-PSLD-VAS, age, and stenosis level have a statistically significant correlation with post-PSLD-VAS, while the duration of the symptoms and OT have an insignificant correlation. Multiple regression showed the effect of pre-PSLD-VAS (β =0.4033, P = 0.000) and stenosis level (β =0.0951, P = 0.021) are statistically significant with a positive coefficient. Conclusions FE-PSLD is an efficacious strategy with favorable outcomes for managing LSS, shown by a significant reduction of pain level with a relatively short follow-up time after the procedure. Preoperative pain level, age, and stenosis level are significantly correlated with postoperative pain level. Based on this experimental study, PSLD can be considered a good strategy for treating lumbar canal stenosis in all age groups and all LSS levels.
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Affiliation(s)
- Victorio
- Department of Neurosurgery, Lamina Pain and Spine Center, South Jakarta, Indonesia
- Department of Neurosurgery, TK. II Moh. Ridwan Meuraksa Military Hospital, East Jakarta, Indonesia
| | - Robert Shen
- Atma Jaya Neuroscience and Cognitive Center, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, North Jakarta, Jakarta, Indonesia
- Department of Emergency, Bunda Pengharapan Hospital, Merauke, South Papua, Indonesia
| | - Mahdian Nur Nasution
- Department of Neurosurgery, Lamina Pain and Spine Center, South Jakarta, Indonesia
- Department of Neurosurgery, Mayapada Hospital Kuningan, South Jakarta, Indonesia
| | - Tjokorda Gde Bagus Mahadewa
- Department of Surgery, Neurosurgery Division, Faculty of Medicine, Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
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Suputtitada A, Chen CPC, Pongpirul K. Mechanical Needling With Sterile Water Versus Lidocaine Injection for Lumbar Spinal Stenosis. Global Spine J 2024; 14:82-92. [PMID: 35510334 PMCID: PMC10676179 DOI: 10.1177/21925682221094533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design: This was a retrospective observational study that assessed the clinical outcome of ageing patients who received ultrasound-guided (USG) mechanical needling with sterile water injection. In addition, the clinical outcome of age-and gender matched patients randomly selected from patients who received needling with sterile water was compared to the patients injected with lidocaine in a 1:1 ratio.Objective: This present study aimed to explore the clinical effects of USG mechanical needling with sterile water injection for lumbar spinal stenosis (LSS).Methods: The data was extracted from the medical records of ageing patients with LSS who received USG injection at the lumbosacral spine by the first author. Low back pain or axial pain, and leg pain or radicular pain were assessed by the visual analogue scale, and gait ability with walking distance were obtained at six different time points.Results: A total of 4328 medical records were examined. Four thousand two hundred and twenty-eight ageing patients received mechanical needling with sterile water injection and found the efficacy lasted up to 6 months. One hundred patients were compared with 100 patients who received lidocaine injection. Those who received lidocaine had pain returned at 3 months and 6 months post-injection.Conclusions: USG mechanical needling with sterile water injection could help relieve axial and radicular pain for at least 6 months. Removal of calcification and fibrosis as well as reduction of sensitization are all possible mechanisms.
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Affiliation(s)
- Areerat Suputtitada
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Carl P. C. Chen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine,Chang Gung University, Taoyuan, Taiwan
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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