Lateral Lumbar Spinal Canal Stenosis: Classification, Pathologic Anatomy and Surgical Decompression

Lee, Casey K.; Rauschning, Wolfgang; Glenn, William V.

doi:10.1097/00007632-198803000-00015

Cited by 245 publications

(169 citation statements)

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“…Lumbar foraminal stenosis is a condition in which a nerve root or spinal nerve is entrapped in the narrowed lumbar a b c S p in a l n e r v e N e r v e r o o t foramen in degenerative lumbar spinal disorders [1][2][3][4][5][6]. The incidence of nerve root entrapment has been reported to be between 8 and 11% in degenerative lumbar disease [26,27].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with degenerative lumbar disease, lumbar foraminal stenosis often causes nerve root entrapment, which is characterized by radicular symptoms affecting the leg [1][2][3][4][5][6]. This condition unfortunately results in failed back surgery syndrome and is the cause of continued postoperative pain because of the difficulty of making a correct diagnosis [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Clinical applications of diffusion magnetic resonance imaging of the lumbar foraminal nerve root entrapment

et al. 2010

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Diffusion-weighted imaging (DWI) can provide valuable structural information about tissues that may be useful for clinical applications in evaluating lumbar foraminal nerve root entrapment. Our purpose was to visualize the lumbar nerve root and to analyze its morphology, and to measure its apparent diffusion coefficient (ADC) in healthy volunteers and patients with lumbar foraminal stenosis using 1.5-T magnetic resonance imaging. Fourteen patients with lumbar foraminal stenosis and 14 healthy volunteers were studied. Regions of interest were placed at the fourth and fifth lumbar root at dorsal root ganglia and distal spinal nerves (at L4 and L5) and the first sacral root and distal spinal nerve (S1) on DWI to quantify mean ADC values. The anatomic parameters of the spinal nerve roots can also be determined by neurography. In patients, mean ADC values were significantly higher in entrapped roots and distal spinal nerve than in intact ones. Neurography also showed abnormalities such as nerve indentation, swelling and running transversely in their course through the foramen. In all patients, leg pain was ameliorated after selective decompression (n = 9) or nerve block (n = 5). We demonstrated the first use of DWI and neurography of human lumbar nerves to visualize and quantitatively evaluate lumbar nerve entrapment with foraminal stenosis. We believe that DWI is a potential tool for diagnosis of lumbar nerve entrapment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical applications of diffusion magnetic resonance imaging of the lumbar foraminal nerve root entrapment

et al. 2010

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“…Stenosis can occur in either or both regions. The nerve root canal has been divided to three zones: lateral recess, foraminal region, and extra-foraminal region (5). The current report focuses on the lateral recess which constitutes the entrance zone for lumbar nerve roots entering the nerve root canal.…”

Section: Introductionmentioning

confidence: 99%

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Birjandian¹,

Emerson²,

Telfeian³

et al. 2017

J. Spine Surg.

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Background: Lateral recess stenosis is a common pathology causing de-novo or residual radicular pain following lumbar spine surgery. Diagnostic criteria and treatment strategies for symptomatic lateral recess stenosis are not well established. Methods:We identified ten patients in our prospective patient database (n=146) who underwent endoscopic interlaminar decompression for unilateral symptomatic lateral recess stenosis. Lateral recess height and angle were measured on axial T2-weighted MRI. Values from the symptomatic side were compared to the contralateral side which served as asymptomatic control. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and leg pain were collected preoperatively, postoperatively and at last follow-up.Results: Preoperative MRI revealed that both lateral recess angle and height were significantly smaller on the symptomatic compared to the asymptomatic side (angle: 19.3˚ vs. 35.7˚; height: 2.9 vs. 5.7 mm; P<0.01).All patients tolerated endoscopic interlaminar decompression well and half of the patients were discharged on the day of surgery. At last follow-up (12.6±1.7 months), 8 out of 10 patients experienced a minimally clinically important improvement of their VAS for ipsilateral leg pain, which improved from 7.2±0.5 preoperatively to 2.5±0.8 postoperatively (P=0.001). The back pain VAS also improved (preoperatively 5.1±1.1 vs. postoperatively 1.7±0.9, P<0.05). The ODI improved from 50±5.8 preoperatively to 22.2±5.1 at last follow-up (P=0.001). One patient experienced persistent leg pain.Conclusions: Lateral recess height and angle correlate with symptomatic lateral recess stenosis which is effectively treated utilizing interlaminar endoscopic lateral recess decompression.

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“…MRI scan showed a slightly bulged intervertebral disc at these levels in the sagittal display but, more signi®cantly, superimposed left L4-5 and L5-S1 extraforaminal disc herniations (Figure 1a). Selective nerve root in®ltration using 2% lidocaine (2 ml for each spinal nerve) followed by radiculography demonstrated caudally displaced L4 spinal nerve at the foraminal exit 8 and a markedly swollen L5 spinal nerve (Figure 1b). These ®ndings were suggestive of a`double-level' (L4-5 and L5-S1 levels) extraforaminal lumbar disc herniation.…”

Section: Casementioning

confidence: 99%

Extraforaminal lumbar disc herniation at two contiguous intervertebral levels

et al. 1997

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We describe two unusual surgical cases who presented with extraforaminal lumbar disc herniation that occurred at two adjacent vertebral levels simultaneously and unilaterally. Magnetic resonance imaging and selective nerve root in®ltration followed by radiculography helped to outline the herniated disc material. Lateral fenestration and microsurgical foraminal widening of the a ected vertebral levels allowed a complete and safe relief of the compressed nerves.

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Lateral Lumbar Spinal Canal Stenosis: Classification, Pathologic Anatomy and Surgical Decompression

Cited by 245 publications

References 0 publications

Clinical applications of diffusion magnetic resonance imaging of the lumbar foraminal nerve root entrapment

Clinical applications of diffusion magnetic resonance imaging of the lumbar foraminal nerve root entrapment

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Extraforaminal lumbar disc herniation at two contiguous intervertebral levels

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