Influence of anatomical variations on lumbar foraminal stenosis pathogenesis

Merckaert, Sophie; Pierzchała, Katarzyna; Kulik, Gerit; Schizas, Constantin

doi:10.1007/s00586-014-3524-3

Cited by 14 publications

(4 citation statements)

References 13 publications

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“…Firstly, a relatively small number of subjects were investigated. Many factors could influence the anatomic structures of the LIVF shape and size, including: age; gender; level; vertebral and pedicle geometries; and the orientation of lumbar facet joints [23, 27–30]. Future studies should sub-divide the subjects into smaller groups to include variables such as age, gender, and body height/weight.…”

Section: Discussionmentioning

confidence: 99%

In vivo dynamic changes of dimensions in the lumbar intervertebral foramen

et al. 2015

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BACKGROUND CONTEXT Previous studies have reported position-dependent changes of the lumbar intervertebral foramen (LIVF) dimensions at different static flexion-extension postures. However, the changes of the LIVF dimensions during dynamic body motion have not been reported. PURPOSE The objective of this study was to investigate the in-vivo dimensions of the LIVF during a dynamic weight-lifting activity. STUDY DESIGN/SETTING A retrospective study. METHODS Ten asymptomatic subjects were recruited for this study. 3D vertebral models of the lumbar segments from L2 to S1 were constructed for each subject using MR images. The lumbar spine was then imaged using a dual fluoroscopic imaging system as the subject performed a dynamic weight-lifting activity from an upper body position of 45° to a maximal extension position. The in-vivo positions of the vertebrae along the motion path were reproduced using the 3D vertebral models and the fluoroscopic images. The minimal area, height, and width of each LIVF during the dynamic body motion were analyzed. RESULTS The LIVF area and width monotonically decreased with lumbar extension at all levels except L5-S1 (p < 0.05). On average, the LIVF area decreased by 7.4 ± 6.7 %, 10.8 ± 7.7 % and 10.0 ± 8.0 % at the L2–3, L3–4 and L4–5 levels, respectively, from the flexion to the upright standing position, and by 6.4 ± 5.0 %, 7.7 ± 7.4 % and 5.1 ± 5.1 %, respectively, from the upright standing to the extension position. LIVF height remained relatively constant at all segments during the dynamic activity. The foramen area, height, and width of the L5-S1 remained relatively constant throughout the activity. CONCLUSIONS Human lumbar foramen dimensions show segment-dependent characteristics during the dynamic weight-lifting activity.

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Section: Discussionmentioning

confidence: 99%

In vivo dynamic changes of dimensions in the lumbar intervertebral foramen

et al. 2015

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“…Fusion seems to be the gold standard for surgical treatment of foraminal stenosis (6)(7)(8)(9)(10). The alternative surgical treatment is minimally invasive PELF without fusion (11 -14).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous full endoscopic lumbar foraminoplasty for adjacent level foraminal stenosis following vertebral intersegmental fusion in an awake and aware patient under local anesthesia: A case report

et al. 2017

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: Percutaneous endoscopic surgery for the lumbar spine has become established in the last decade. It requires only an 8 mm skin incision, causes minimal damage to the paravertebral muscles, and can be performed under local anesthesia. With the advent of improved equipment, in particular the high-speed surgical drill, the indications for percutaneous endoscopic surgery have expanded to include lumbar spinal canal stenosis. Transforaminal percutaneous endoscopic discectomy has been used to treat intervertebral stenosis. However, it has been reported that adjacent level disc degeneration and foraminal stenosis can occur following intervertebral segmental fusion. When this adjacent level pathology becomes symptomatic, additional fusion surgery is often needed. We performed minimally invasive percutaneous full endoscopic lumbar foraminoplasty in an awake and aware 50-year-old woman under local anesthesia. The procedure was successful with no complications. Her radiculopathy, including muscle weakness and leg pain due to impingement of the exiting nerve, improved after the surgery.

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“…In other reports, foraminal stenosis was attributed to facet joint hyperplasia and adjacent disc collapse after fusion [24,25,27]. Decompression without fusion may not be adequate treatment for ASD that includes adjacent foraminal stenosis because the pathology is instability of the adjacent level [9,26,[28][29][30]. However, extension of the fusion segment could increase both rigidity and the risk of future ASD.…”

Section: Treatment For Asdmentioning

confidence: 99%

Advantages of Revision Transforaminal Full-Endoscopic Spine Surgery in Patients who have Previously Undergone Posterior Spine Surgery

Yagi

Kishima

Tezuka

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Revision lumbar spine surgery via a posterior approach is more challenging than primary surgery because of epidural or perineural scar tissue. It demands more extensive removal of the posterior structures to confirm intact bony landmarks and could cause iatrogenic instability postoperatively; therefore, fusion surgery is often selected. However, adjacent segment disease after fusion surgery could be a problem, and further exposure of the posterior muscles could result in multiple operated back syndrome. To address these problems, we now perform transforaminal full-endoscopic spine surgery (TF-FES) as revision surgery in patients who have previously undergone posterior lumbar surgery. There have been several reports on the advantages of TF-FES, which include feasibility of local anesthesia, minimal invasiveness to posterior structures, and less scar tissue with fewer adhesions. To assess the clinical outcomes of revision TF-FES and outline its advantages. Forty-eight consecutive patients who underwent revision TF-FES (at 60 levels) under local anesthesia. Clinical outcomes of TF-FES performed as revision surgery in patients with a history of posterior lumbar spine surgery. Intraoperative blood loss, operating time, and complication rate were evaluated. Postoperative outcomes were assessed using the modified Macnab criteria and visual analog scale (VAS) scores for leg pain, back pain, and leg numbness. We also compared the outcome of revision FES with that of primary FES. Mean operating time was 70.5±14.4 (52–106) min. Blood loss was unmeasurable. The clinical outcomes were rated as excellent at 16 levels (26.7%), good at 28 (46.7%), fair in 10 (16.7%), and poor at 6 (10.0%). The mean preoperative VAS score was 6.0±2.6 for back pain, 6.8±2.4 for leg pain, and 6.3±2.8 for leg numbness. At the final follow-up, the mean postoperative VAS scores for were 4.3±2.5, 3.8±2.6, and 4.6±3.2, respectively. VAS scores for all three parameters were significantly improved (p<0.05). There was no significant difference in operating time, intraoperative blood loss, or the complication rate between revision FES and primary FES. Clinical outcomes of revision TF-FES in patients with a history of posterior lumbar spine surgery were acceptable (excellent and good in 73.4% of cases). TF-FES can preserve the posterior structures and avoid scar tissue and adhesions. Therefore, TF-FES could be an effective procedure for patients who have previously undergone posterior lumbar spine surgery.

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Influence of anatomical variations on lumbar foraminal stenosis pathogenesis

Cited by 14 publications

References 13 publications

In vivo dynamic changes of dimensions in the lumbar intervertebral foramen

In vivo dynamic changes of dimensions in the lumbar intervertebral foramen

Percutaneous full endoscopic lumbar foraminoplasty for adjacent level foraminal stenosis following vertebral intersegmental fusion in an awake and aware patient under local anesthesia: A case report

Advantages of Revision Transforaminal Full-Endoscopic Spine Surgery in Patients who have Previously Undergone Posterior Spine Surgery

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