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The Spaghetti Sign: Nerve Root Redundancy in Lumbar Spinal Stenosis.

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Severe redundant nerve roots (RNR), or the spaghetti sign (SS), reliably indicate lumbar spinal stenosis (LSS). However, RNR presence does not negatively impact surgical outcomes for LSS patients.

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LumbarNerve root redundancyODISpaghetti signSpinal stenosis

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Area of Science:

  • Neurosurgery
  • Radiology
  • Orthopedics

Background:

  • Redundant nerve roots (RNRs) are radiographic findings associated with lumbar spinal stenosis (LSS).
  • Previous research suggests RNRs may negatively predict surgical outcomes.
  • The "spaghetti sign" (SS) is an informal term for severe RNR.

Purpose of the Study:

  • To evaluate a grading scale for RNR severity.
  • To characterize the association between RNR and LSS.
  • To investigate the clinical implications of RNR on surgical outcomes.

Main Methods:

  • Retrospective chart review of 72 patients undergoing lumbar spine surgery.
  • Preoperative T2 MRI scans graded for stenosis and RNR severity by three reviewers.
  • SS defined as RNR score ≥2; Oswestry Disability Index (ODI) analyzed pre- and postoperatively.

Main Results:

  • 98% of patients had severe stenosis (score ≥3); 35% had SS.
  • SS was 100% specific for high-grade stenosis.
  • Postoperative ODI scores improved significantly, with no difference based on RNR or SS severity.

Conclusions:

  • SS is a reliable marker for severe LSS.
  • RNR presence, including SS, is not a negative prognostic indicator for LSS surgical outcomes.