Correlation between leg pain at rest and spinal nerve edema in symptomatic lumbar foraminal stenosis

Extreme lateral interbody fusion (XLIF) has been widely used for minimally invasive anterior lumbar interbody fusion (ALIF), but an approach to L5-S1 is difficult because of the iliac crest. In the current study, we present 2 cases using minimally invasive oblique lateral interbody fusion (OLIF) of L5-S1. The patients showed foraminal stenosis between L5 and S1 and severe low back and leg pain. The patients were placed in a lateral decubitus position and underwent OLIF surgery (using a cage and bone graft from the iliac crest) without posterior decompression. Posterior screws were used in the patients. Pain scores significantly improved after surgery. There was no spinal nerve, major vessel, peritoneal, or urinary injury. OLIF surgery was minimally invasive and produced good surgical results without complications.

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Effectiveness of Percutaneous Transforaminal Adhesiolysis in Patients with Lumbar Neuroforaminal Spinal Stenosis

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/e37 ◽

2013 ◽

Vol 1;16 (1;1) ◽

pp. E37-E43

Author(s):

Chan Hong Park

Keyword(s):

Spinal Stenosis ◽

Spinal Nerve ◽

Leg Pain ◽

Neurogenic Claudication ◽

Foraminal Stenosis ◽

Short Term ◽

Satisfaction Scale ◽

Patient Response ◽

Epidural Steroid Injections

Background: Lumbar foraminal spinal stenosis (LFSS) is a narrowing of the bony exit of a nerve root, which causes mechanical compression of spinal nerve roots. Low back pain and/or leg pain, and possibly neurogenic claudication, may result due to mechanical neural compression. Transforaminal epidural steroid injections (TFESIs) are commonly used for treating LFSS. Patients refractory to TFESIs may benefit from percutaneous epidural adhesiolysis. Objective: Our intent was to assess transforaminal adhesiolysis (TFA) as treatment for LFSS, analyzing patient response by severity of stenosis and evaluating the short-term effectiveness of TFA. Study Design: Prospective study. Methods: Following IRB approval, 35 patients with LFSS were enrolled, all of whom underwent magnetic resonance imaging (MRI) of the lumbar spine. Sagittal MRI views were evaluated to grade the severity of LFSS. TFA was routinely conducted in the operating room. One hour after the procedure, each patient received 6 mL of 10% sodium chloride, infused over 30 minutes, with monitoring. Posttreatment outcomes were determined at 2 weeks and 3 months using a 5-point patient satisfaction scale. To test predictive value, patients were stratified by response (improvement versus no improvement). Results: Improvement (defined as little pain, moderate pain, or no pain) was observed in 25 patients (71.4%) at 2 weeks and in 22 patients (62.8%) at 3 months following the procedure. Among patients showing improvement, those with Grade 3 spinal stenosis outnumbered those with Grade 2. At the 3-month follow-up, no statistically significant correlations between pain relief and the grade of LFSS was evident. Limitations: Secondary outcomes were not measured and the follow-up period was relatively brief. Conclusion: Short-term results indicate that percutaneous TFA is an effective treatment for LFSS, although therapeutic outcomes and the severity of LFSS showed no correlation. Key words: Lumbar, foraminal stenosis, adhesiolysis, effectiveness.

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Percutaneous Endoscopic Lumbar Foraminotomy

Neurosurgery ◽

10.1227/neu.0000000000000361 ◽

2014 ◽

Vol 75 (2) ◽

pp. 124-133 ◽

Cited By ~ 76

Author(s):

Yong Ahn ◽

Hyun-Kyong Oh ◽

Ho Kim ◽

Sang-Ho Lee ◽

Haeng-Nam Lee

Keyword(s):

Visual Analog Scale ◽

Oswestry Disability Index ◽

Visual Analog Scale Score ◽

Leg Pain ◽

Foraminal Stenosis ◽

Analog Scale ◽

Lumbar Foraminal Stenosis ◽

Endoscopic Techniques ◽

Post Surgery ◽

The Mean

Abstract BACKGROUND: Although several authors have reported the use of endoscopic techniques to treat lumbar foraminal stenosis, the practical application of these techniques has been limited to soft disc herniation. OBJECTIVE: To describe the details of the percutaneous endoscopic lumbar foraminotomy (ELF) technique for bony foraminal stenosis and to demonstrate the clinical outcomes. METHODS: Two years of prospective data were collected from 33 consecutive patients with lumbar foraminal stenosis who underwent ELF. The surgical outcomes were assessed using the visual analog scale, Oswestry Disability Index, and modified MacNab criteria. The procedure begins at the safer extraforaminal zone rather than the riskier intraforaminal zone. Then, a full-scale foraminal decompression can be performed using a burr and punches under endoscopic control. RESULTS: The mean age of the 18 female and 15 male patients was 64.2 years. The mean visual analog scale score for leg pain improved from 8.36 at baseline to 3.36 at 6 weeks, 2.03 at 1 year, and 1.97 at 2 years post-surgery (P < .001). The mean Oswestry Disability Index improved from 65.8 at baseline to 31.6 at 6 weeks, 19.7 at 1 year, and 19.3 at 2 years post-surgery (P < .001). Based on the modified MacNab criteria, excellent or good results were obtained in 81.8% of the patients, and symptomatic improvements were obtained in 93.9%. CONCLUSION: Percutaneous ELF under local anesthesia could be an efficacious surgical procedure for the treatment of foraminal stenosis. This procedure may offer safe and reproducible results, especially for elderly or medically compromised patients.

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Sacral plexus disorder caused by a wooden toothpick in the rectum

BMJ Case Reports ◽

10.1136/bcr-2020-238690 ◽

2021 ◽

Vol 14 (1) ◽

pp. e238690

Author(s):

Takuro Endo ◽

Taku Sugawara ◽

Naoki Higashiyama

Keyword(s):

Lower Limb ◽

Spinal Nerve ◽

Leg Pain ◽

Sacral Plexus ◽

Lateral Recess ◽

Lateral Recess Stenosis ◽

Preoperative Ct ◽

History Of ◽

History Of Pain ◽

The Right

A 67-year-old man presented with a 2-month history of pain in his right buttock and lower limb. MRI depicted right L5/S1 lateral recess stenosis requiring surgical treatment; however, preoperative CT showed an approximately 7 cm long, thin, rod-shaped structure in the rectum, which was ultimately determined to be an accidentally ingested toothpick. It was removed surgically 6 days after diagnosis, because right leg pain worsened rapidly. The pain disappeared thereafter, and the symptoms have not recurred since. The pain might have been localised to the right buttock and posterior thigh in the early stages because the fine tip of the toothpick was positioned to the right of the anterior ramus of the S2 spinal nerve. Although sacral plexus disorder caused by a rectal foreign body is extremely rare, physicians should be mindful to avoid misdiagnosis.

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Is multidetector computed tomography comparable to magnetic resonance imaging for assessment of lumbar foraminal stenosis?

Acta Radiologica ◽

10.1177/0284185116639766 ◽

2016 ◽

Vol 58 (2) ◽

pp. 197-203

Author(s):

Woo Young Kang ◽

Joong Mo Ahn ◽

Joon Woo Lee ◽

Eugene Lee ◽

Yun Jung Bae ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Multidetector Computed Tomography ◽

Excellent Agreement ◽

Observer Agreement ◽

Kappa Statistics ◽

Foraminal Stenosis ◽

Resonance Imaging ◽

Lumbar Foraminal Stenosis

Background Both multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are used for assessment of lumbar foraminal stenosis (LFS). Therefore, it is relevant to assess agreement between these imaging modalities. Purpose To determine intermodality, inter-, and intra-observer agreement for assessment of LFS on MDCT and MRI. Material and Methods A total of 120 foramina in 20 patients who visited our institution in January and February 2014 were evaluated by six radiologists with different levels of experience. Radiologists evaluated presence and severity of LFS on sagittal CT and MR images according to a previously published LFS grading system. Intermodality agreement was analyzed by using weighted kappa statistics, while inter- and intra-observer agreement were analyzed by using intraclass correlation coefficients (ICCs) and kappa statistics. Results Overall intermodality agreement was moderate to good (kappa, 0.478–0.765). In particular, two professors and one fellow tended to overestimate the degree of LFS on CT compared with MRI. For inter-observer agreement of all six observers, ICCs indicated excellent agreement for both CT (0.774) and MRI (0.771), while Fleiss’ kappa values showed moderate agreement for CT (0.482) and MRI (0.575). There was better agreement between professors and fellows compared with residents. For intra-observer agreement, ICCs indicated excellent agreement, while kappa values showed good to excellent agreement for both CT and MRI. Conclusion MDCT was comparable to MRI for diagnosis and assessment of LFS, especially for experienced observers. However, there was a tendency to overestimate the degree of LFS on MDCT compared with MRI.

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