| Objective:Based on the idea of "qi deficiency and pathogenic factor stagnation",to analyze the clinical significance of redundant nerve roots of the cauda equina in lumbar spinal stenosis patients by comparing the positive and negative groups of redundant nerve roots of the cauda equina in patients.Methods:157 inpatients with lumbar spinal stenosis were retrospectively analyzed.According to whether there was redundant nerve roots of the cauda equina on MR,it was divided into two groups:positive group and negative group.Compared with the general data of the two groups,the cross-sectional area of dural sac,the minimunm effective sagittal diameter of the spinal canal,the ligamentum flavum area of L4/5 segment and the choice of treatment were different.According to the syndrome types of traditional Chinese medicine,they were divided into three subgroups,and the difference of degree of stenosis among the three groups was compared.The two groups were divided into four subgroups according to conservative treatment and surgical treatment.The VAS scores and ODI scores of patients with conservative treatment and surgical treatment were compared according to the redundant nerve roots sign.The data were analyzed by SPSS 23.0 software.Results:There was no significant difference in sex composition,age,height and weight between the two groups(P>0.05),but there was significant difference in treatment choice and course of disease between the two groups(P<0.05).The intra-group Kappa value was 0.882 and the Kappa value between groups was 0.897 According to different doctors determination of he redundant nerve roots sign.There was a significant difference(P<0.05)in the distribution of TCM syndromes between the two groups,There were significant differences(P<0.05)in effective sagittal diameter and cross-sectional area of dural sac among the three types of syndrome.The cross-sectional area of dural sac at the narrowest level was 42.03125.55mm2 in the positive group and 68.36±19.42mm2 in the negative group,with significant difference(P<0.05),The area under the ROC curve of dural sac cross-sectional area and redundant nerve root was 0.792(95%CI,0.72-0.87),the sensitivity was 84.4%,the specificity was 70.1%,and the optimal threshold was 50.65 mm2.The effective sagittal diameter of the positive group was 5.45±2.47mm,and the effective sagittal diameter of the negative group was 7.27±1.48mm,and the difference was statistically significant(P<0.05),The area under the ROC curve of effective sagittal diameter and redundant nerve root sign was 0.735(95%CI,0.65-0.82),the sensitivity was 82.2%and the specificity was 67.2%.The optimal threshold was 6.15mm.The ligamentum flavum area at L4/5 level in the positive group was 130.21±33.11mm2,and the ligamentum flavum area at L4/5 level in the negative group was 116.97±25.62mm2,and the difference was statistically significant(P<0.05),The area under the ROC curve of ligamentum flavum area of the L4/5-level and the redundant nerve roots was 0.633(95%CI,0.54-0.73),the sensitivity was 61.3%,the specificity was 68.3%,and the optimum hreshold was 126.95 mm2.The difference of treatment choice between the two groups was statistically significant(P<0.05),and the positive patients with redundant nerve roots were more likely to choose surgical treatment(P<0.05,OR=5.11,95%CI 2.576-10.143);The area under the ROC curve of root redundancy sign and selective operation was 0.690(95%CI,0.606-0.774),the sensitivity was 63.0%,and the specificity was 75.0%.The baseline VAS score was higher in the positive group of patients who received conservative treatment,the difference was statistically significant(P=0.001),and the VAS score was higher in the positive group than in the negative group at follow-up,the difference was statistically significant(P<0.05).There was no statistically significant difference(P>0.05)in VAS scores in the follow-up of the two groups undergoing surgical treatment;The baseline ODI scores of patients in the positive group were higher than those in the negative group,and the difference was statistically significant(P=0.007).The ODI score of the positive group receiving conservative treatment was higher than that of the negative group at follow-up,and the difference was statistically significant(P<0.05).The ODI score of the positive group was higher at the first month and the third month at follow-up(P<0.05),at the sixth month follow-up,the ODI score of the positive group was still higher,but there was no significant difference(P>0.05).ConcIusion:The proportion of Qi deficiency and blood stasis was greater in patients who were positive with redundant nerve roots,while the degree of degenerative spinal stenosis was more serious in patients with QI deficiency and blood stasis type;The stenosis degree of spinal canal was higher,the clinical score was worse,and the conservative treatment effect was poor in the patients with positive of redundant nerve roots,The short-term effect of surgical treatment was worse than that of negative patients,but the long-term effect could be achieved.This sign may help orthopaedicians as one of the indications for selecting surgical treatment for patients. |
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