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Excessive swelling of nerve roots

Important factor for recurring sciatica after lumbar surgery

Exzessive Schwellung der Nervenwurzeln

Wichtiger Faktor für ein rezidivierendes Ischiassyndrom nach Lendenwirbelsäulenoperation

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Abstract

Objective

The aim of the study was to investigate the occurrence of unexpectedly swollen nerve roots and to investigate the relationship between nerve root edema and recurrent radicular pain.

Methods

During the period from August 2010 to August 2015, a total of 462 patients with degenerative lumbar disease underwent surgery in this study group. Magnetic resonance imaging (MRI) was used to evaluate the details of the nerve root. Of the patients with recurring radiating pain 13 met the inclusion criteria of the study group and 24 patients without any complications volunteered as the control group. The visual analog scale (VAS), Oswestry Disability Index (ODI), and medical outcomes study item short form health survey (SF-36) were used to evaluate the clinical outcomes.

Results

The preoperative diameter of the nerve root showed no significant difference between the two groups (P = 0.28). The postoperative nerve diameter of the study group was larger than that of the control group (P < 0.01). The initial operation improved the symptoms and the VAS was significantly decreased (P < 0.01). After recurrence of the neuralgia, the VAS score significantly increased (P < 0.01). The pain of the study group improved to the same level as that of the control group 4 weeks after subsequent surgery (P = 0.47), while the quality of life was still lower than that of the control group (P < 0.05). The scores collected 3 months after surgery showed that the clinical outcomes were not different between the two groups (P > 0.05).

Conclusion

In surgery for degenerative lumbar disease accompanied by nerve root edema, excessive nerve root swelling is an important factor for recurrent radiating pain. With a properly carried out intervention in the re-exploration, the recurrent symptoms can be gradually relieved.

Zusammenfassung

Ziel

Das Ziel dieser Studie war es, das Auftreten unerwarteter Schwellungen der Nervenwurzeln sowie den Zusammenhang zwischen einem Nervenwurzelödem und rezidivierenden radikulären Schmerzen zu untersuchen.

Methoden

In dieser Studiengruppe wurden im Zeitraum zwischen August 2010 und August 2015 insgesamt 462 Patienten mit einer degenerativen Erkrankung der Lendenwirbelsäule operiert. Die detaillierte Beurteilung der Nervenwurzel erfolgte mittels Magnetresonanztomographie (MRT). Von den Patienten mit rezidivierenden ausstrahlenden Schmerzen erfüllten 13 die Einschlusskriterien der Studiengruppe, und 24 Patienten ohne Komplikationen stellten sich freiwillig als Kontrollgruppe zur Verfügung. Die visuelle Analogskala (VAS), der Oswestry-Disability-Index (ODI) und das Item für medizinisches Outcome im Short-form Health Survey (SF-36) wurden für die Beurteilung der klinischen Ergebnisse verwendet.

Ergebnisse

Der präoperative Durchmesser der Nervenwurzel zeigte keinen signifikanten Unterschied zwischen den beiden Gruppen (p = 0,28). Der postoperative Nervendurchmesser war in der Studiengruppe größer als in der Kontrollgruppe (p < 0,01). Die initiale Operation verbesserte die Symptome, und die VAS-Werte sanken signifikant (p < 0,01). Nach dem rezidivierten Auftreten der Neuralgie stieg der VAS-Score signifikant (p < 0,01). Die Schmerzen in der Studiengruppe verbesserten sich in gleichem Maße wie in der Kontrollgruppe 4 Wochen nach der Folgeoperation (p < 0,47), während die Lebensqualität noch immer niedriger war als in der Kontrollgruppe (p < 0,05). Die 3 Monate nach der Operation erfassten Scores zeigten, dass sich die klinischen Ergebnisse in den beiden Gruppen nicht unterschieden (p < 0,05).

Schlussfolgerung

Die exzessive Schwellung der Nervenwurzel stellt bei Operationen degenerativer Erkrankungen der Lendenwirbelsäule mit Nervenwurzelödem einen wichtigen Faktor für rezidivierende ausstrahlende Schmerzen dar. Durch die korrekte Ausführung des Folgeeingriffs können diese wiederkehrenden Symptome nach und nach gelindert werden.

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Abbreviations

DRG:

Dorsal root ganglia

MRI:

Magnetic resonance imaging

ODI:

Oswestry disability index

PLIF:

Posterior lumbar interbody fusion

PTED:

Percutaneous transforaminal endoscopic discectomy

SF-36:

Medical outcomes study item short form health survey

TNF-alpha:

Tumor necrosis factor-alpha

VAS:

Visual analog scale

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Funding

This work was supported in part by grants from the National Natural Science Foundation of China (81702190, Feng Cai) and the Natural Science Foundation of Jiangsu Province (BK20170370, Feng Cai).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, 215006, Suzhou, China

    Yu Feng, Feng Cai, Liang Chen, Yong Gu, De-Chun Geng, Hui-Lin Yang & Tian-Si Tang

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  1. Yu Feng
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  2. Feng Cai
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  3. Liang Chen
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  4. Yong Gu
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  5. De-Chun Geng
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Corresponding author

Correspondence to Liang Chen.

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Conflict of interest

Y. Feng, F. Cai, L. Chen, Y. Gu, D.-C. Geng, H.-L. Yang and T.-S. Tang declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

Additional information

Yu Feng and Feng Cai contributed equally to this article.

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Feng, Y., Cai, F., Chen, L. et al. Excessive swelling of nerve roots. Orthopäde 49, 502–509 (2020). https://doi.org/10.1007/s00132-019-03794-7

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  • DOI: https://doi.org/10.1007/s00132-019-03794-7

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