Extraforaminal compression of the L5 nerve: An anatomical study with application to failed posterior decompressive procedures

Tubbs, R. Shane; Iwanaga, Joe; Aly, Islam; Moisi, Marc; Hanscom, David; Loukas, Marios; Oskouian, Rod J.

doi:10.1016/j.jocn.2017.03.051

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…In recent years, only decompression via the posterolateral approaches such as the inter- or intramuscular route has gained popularity as a surgical intervention for LSEFL [ 6 ]. However, achieving surgical access to the L5–S1 extraforaminal region is complicated owing to the fact that the lumbosacral extraforaminal space has unique anatomical features and that the region is deeply located comparing with the upper lumbar segments [ 5 8 ]. Moreover, the prominent iliac crest may cause narrowing of the surgical corridor through the posterolateral approach.…”

Section: Discussionmentioning

confidence: 99%

“…Extraforaminal disc herniation at L5–S1 accounts for approximately 2%–4% of all symptomatic lumbar disc herniations. [ 1 2 ] In contrast, several researchers have reported that extraforaminal lumbar nerve compression by bony or ligamentous structures can cause L5 radiculopathy from the first description by Wiltse et al [ 3 ], and it has been recently hypothesized that the incidence of these lesions might have been underestimated, particularly in the elderly [ 2 4 5 ]. Nevertheless, lumbosacral extraforaminal lesions (LSEFLs) are considerably more uncommon than intraspinal canal lesions at L4–L5 as the cause of L5 radiculopathy.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, lumbosacral extraforaminal lesions (LSEFLs) are considerably more uncommon than intraspinal canal lesions at L4–L5 as the cause of L5 radiculopathy. Consequently, LSEFLs are often misdiagnosed and overlooked, resulting in the failed back surgery syndrome [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Minimally Invasive Transtubular Endoscopic Decompression for L5 Radiculopathy Induced by Lumbosacral Extraforaminal Lesions

et al. 2018

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Study DesignRetrospective study.PurposeThis study aimed to evaluate the efficacy of minimally invasive transtubular endoscopic decompression for the treatment of lumbosacral extraforaminal lesion (LSEFL).Overview of LiteratureConventional procedures for surgical decompression for the treatment of LSEFL involve certain technical challenges because the lumbosacral extraforaminal region has unique anatomical features. Moreover, the efficacy of minimally invasive procedures performed via the posterolateral approach for LSEFL has been reported.MethodsTwenty-five patients who had undergone minimally invasive transtubular endoscopic decompression for the treatment of LSEFL and could be followed up for at least 1 year postoperatively were enrolled. Five of these patients had a history of lumbar surgery, and seven had concomitant adjacent-level spinal stenosis. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) lumbar score, numeric rating scale (NRS), and the JOA Back Pain Evaluation Questionnaire (JOABPEQ). The mean postoperative follow-up (FU) duration was 3.8 years.ResultsAll procedures could be completed without any severe surgical complications, and all patients could resume their previous activity level within 1 month postoperatively. The JOA score significantly increased from 14.1±4.0 at baseline to 23.1±3.7 at the 1-year FU and 22.1±3.8 at the last FU. Similarly, there were significant improvements in the postoperative NRS and JOABPEQ scores. An additional surgery was performed in two patients (8%) during the FU period. Patients with degenerative scoliosis exhibited significantly poorer outcomes compared with those without this condition.ConclusionsTranstubular endoscopic decompression can overcome certain technical challenges involved in the conventional procedures for LSEFL treatment; therefore, it can be recommended as a useful procedure for treating LSEFL. This procedure can provide some benefits to LSEFL patients and offer a well-illuminated surgical field and high surgical safety for the surgeon. However, the procedure should be carefully adapted for LSEFL patients with concomitant degenerative scoliosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Minimally Invasive Transtubular Endoscopic Decompression for L5 Radiculopathy Induced by Lumbosacral Extraforaminal Lesions

et al. 2018

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“…A preoperative diagnosis of extraforaminal stenosis at L5-S1 is important be-cause a lack of diagnosing extraforaminal stenosis at L5-S1 can result in failed back surgery syndrome. 2,3 In the past, using a paraspinal approach for microsurgical decompression of foraminal lesions had been considered the gold standard for surgical treatment of lumbar foraminal or extraforaminal stenosis. 1,4,5 But, access to the L5-S1 extraforaminal region is difficult for 2 reasons: (1) the distance between the L5 TP and sacral ala is This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.…”

Section: Introductionmentioning

confidence: 99%

Unilateral Biportal Endoscopy for Decompression of Extraforaminal Stenosis at the Lumbosacral Junction: Surgical Techniques and Clinical Outcomes

Park¹,

Son²,

Park³

et al. 2021

Neurospine

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Objective: The aims of this study were to describe the unilateral biportal endoscopic (UBE) technique for decompression of extraforaminal stenosis at L5–S1 and evaluate 1-year clinical outcomes. Especially, we evaluated compression factors of extraforaminal stenosis at L5–S1 and described the surgical technique for decompression in detail.Methods: Thirty-five patients who underwent UBE decompression for extraforaminal stenosis at L5–S1 between March 2018 and February 2019 were enrolled. Clinical results were analyzed using the MacNab criteria, the visual analogue scale (VAS) for back and leg pain, and the Oswestry Disability Index (ODI). Compression factors evaluated pseudoarthrosis within the transverse process of L5 and ala of sacrum, disc bulging with or without osteophytes, and the thickened lumbosacral and extraforaminal ligament.Results: The mean back VAS was 3.7 ± 1.8 before surgery, which dropped to 2.3 ± 0.8 at 1-year postoperative follow-up (p < 0.001). There was a significant drop in postoperative mean VAS for leg pain from 7.2 ± 1.1 to 2.3 ± 1.2 at 1 year (p < 0.001). The ODI was 61.5 before surgery and 28.6 (p < 0.001). Pseudoarthrosis between the transverse process and the ala was noted in all cases (35 of 35, 100%). Pure disc bulging was seen in 12 patients (34.3%), and disc bulging with osteophytes was demonstrated in 23 patients. The thickened lumbosacral and extraforaminal ligament were identified in 19 cases (51.4%). No complications occurred in any of the patients.Conclusion: In the current study, good surgical outcomes without complications were achieved after UBE decompression for extraforaminal stenosis at L5–S1.

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Challenging Cases Treated with UBE: The Far-Out Syndrome

Quillo-Olvera

Quillo-Reséndiz

et al. 2022

Unilateral Biportal Endoscopy of the Spine

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Extraforaminal compression of the L5 nerve: An anatomical study with application to failed posterior decompressive procedures

Cited by 3 publications

References 19 publications

Minimally Invasive Transtubular Endoscopic Decompression for L5 Radiculopathy Induced by Lumbosacral Extraforaminal Lesions

Minimally Invasive Transtubular Endoscopic Decompression for L5 Radiculopathy Induced by Lumbosacral Extraforaminal Lesions

Unilateral Biportal Endoscopy for Decompression of Extraforaminal Stenosis at the Lumbosacral Junction: Surgical Techniques and Clinical Outcomes

Challenging Cases Treated with UBE: The Far-Out Syndrome

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