scholarly journals Lumbar Lateral Recess Decompression: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E394-E394 ◽  
Author(s):  
Siri Sahib S Khalsa ◽  
Yamaan S Saadeh ◽  
Timothy J Yee ◽  
Michael J Strong ◽  
Brandon W Smith ◽  
...  
Keyword(s):  
Nerve Root ◽  
Ligamentum Flavum ◽  
Foraminal Stenosis ◽  
Mri Findings ◽  
Neural Foramen ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Lumbar Nerve Root ◽  
Patient Consent ◽  
Magnetic Resonance Imaging Mri

Abstract Lateral recess stenosis is a common cause of lumbar radiculopathy in adults. A lumbar nerve root travels in the lateral recess prior to exiting the spinal canal via the neural foramen. In the lateral recess, the traversing nerve root is susceptible to compression by the degenerative hypertrophy of the medial facet in addition to hypertrophied ligamentum flavum and herniated intervertebral disc.1 These degenerative changes are also typically associated with neural foraminal stenosis. Surgical treatment in unilateral cases consists of hemilaminectomy, medial facetectomy, foraminotomy, and, if applicable, microdiscectomy. In this video, we present a case of a 64-yr-old male presenting with progressive left L5 radiculopathy refractory to conservative management, with magnetic resonance imaging (MRI) findings of left L4-5 foraminal and lateral recess stenosis. We demonstrate the operative steps to complete a left L4-5 hemilaminectomy, medial facetectomy, foraminotomy, and microdiscectomy. Appropriate patient consent was obtained.

Lumbar nerve root compression by synovial cysts of the ligamentum flavum

1984 ◽  
Vol 60 (3) ◽  
pp. 617-620 ◽  
Author(s):  
Adel F. Abdullah ◽  
Robert W. Chambers ◽  
Dennis P. Daut
Keyword(s):  
Nerve Root ◽  
Ligamentum Flavum ◽  
Nerve Root Compression ◽  
Nerve Roots ◽  
Content Type ◽  
Lumbar Nerve Root ◽  
Synovial Cysts ◽  
Fine Print

✓ Synovial cysts of the ligamentum flavum, measuring 1 cm in diameter, caused compression of the lumbar nerve roots in four patients. The authors discuss the association of these cysts with advanced focal spondylosis, and speculate on their etiology.

scholarly journals Accurate location and minimally invasive treatment of lumbar lateral recess stenosis with combined SNRB and PTED

2019 ◽  
Vol 48 (3) ◽  
pp. 030006051988481
Author(s):  
Bing Yue ◽  
Fang Shen ◽  
Zhi-Fang Ye ◽  
Ze-Hao Wang ◽  
Hui-Lin Yang ◽  
...  
Keyword(s):  
Nerve Root ◽  
Remission Rate ◽  
Invasive Treatment ◽  
Nerve Roots ◽  
Lateral Recess ◽  
Conservative Group ◽  
Lateral Recess Stenosis ◽  
Endoscopic Discectomy ◽  
Functional Scores ◽  
Selective Nerve Root Block

Objective To establish a management strategy for multi-segment lumbar lateral recess stenosis. Methods A retrospective study was performed in patients in whom suspected responsible nerve roots underwent sequential selective nerve root block (SNRB). Based on pain remission rate after blocking, the contribution of nerve root compression to symptoms was classified as absolutely (≥70%) or relatively (30–70%) responsible or non-responsible (<30%). Conservative treatment was continued if visual analogue scale (VAS) at 3 days after blocking a single nerve root or VAS at 3 days after blocking multiple nerve roots was ≥50%; otherwise, percutaneous transforaminal endoscopic discectomy (PTED) was performed. Pain and functional scores were evaluated on day 3, 6 months and 1 year after SNRB or PTED. Results Fifty-seven of 80 patients had a single absolutely responsible root, 20 had 2 responsible roots, and 3 had 3 responsible roots. Among them, 41, 10, and 1 patient underwent PTED, respectively. Both the PTED and conservative groups improved significantly in VAS remission rate and functional scores compared with admission. Moreover, the PTED group had a better VAS remission rate compared with the conservative group. Conclusion A combination of SNRB with PTED was effective for diagnosing and treating multi-segment lumbar lateral recess stenosis.

Simplified Universal Grading of Lumbar Spine MRI Degenerative Findings: Inter-Reader Agreement of Non-Radiologist Spine Experts

Pain Medicine ◽  
2021 ◽  
Author(s):  
Nityanand Miskin ◽  
Zacharia Isaac ◽  
Yi Lu ◽  
Melvin C Makhni ◽  
Danielle L Sarno ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Spinal Stenosis ◽  
Degenerative Changes ◽  
Grading System ◽  
Foraminal Stenosis ◽  
Substantial Agreement ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Facet Arthropathy ◽  
Spine Mri

Abstract Objective 1) To describe a simplified multidisciplinary grading system for the most clinically relevant lumbar spine degenerative changes. 2) To measure the inter-reader variability among non-radiologist spine experts in their use of the classification system for interpretation of a consecutive series of lumbar spine magnetic resonance imaging (MRI) examinations. Methods ATS multidisciplinary and collaborative standardized grading of spinal stenosis, foraminal stenosis, lateral recess stenosis, and facet arthropathy was developed. Our institution’s picture archiving and communication system was searched for 50 consecutive patients who underwent non-contrast MRI of the lumbar spine for chronic back pain, radiculopathy, or symptoms of spinal stenosis. Three fellowship-trained spine subspecialists from neurosurgery, orthopedic surgery, and physiatry interpreted the 50 exams using the classification at the L4–L5 and L5–S1 levels. Inter-reader agreement was assessed with Cohen’s kappa coefficient. Results For spinal stenosis, the readers demonstrated substantial agreement (κ = 0.702). For foraminal stenosis and facet arthropathy, the three readers demonstrated moderate agreement (κ = 0.544, and 0.557, respectively). For lateral recess stenosis, there was fair agreement (κ = 0.323). Conclusions A simplified universal grading system of lumbar spine MRI degenerative findings is newly described. Use of this multidisciplinary grading system in the assessment of clinically relevant degenerative changes revealed moderate to substantial agreement among non-radiologist spine physicians. This standardized grading system could serve as a foundation for interdisciplinary communication.

scholarly journals Imaging diagnosis of lumbar foraminal stenosis in the fifth lumbar nerve root: reliability and reproducibility of T1-weighted three-dimensional lumbar MRI

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Ko Hashimoto ◽  
Yasuhisa Tanaka ◽  
Takumi Tsubakino ◽  
Takeshi Hoshikawa ◽  
Tomowaki Nakagawa ◽  
...  
Keyword(s):  
Nerve Root ◽  
Three Dimensional ◽  
Foraminal Stenosis ◽  
Imaging Diagnosis ◽  
Lumbar Foraminal Stenosis ◽  
Lumbar Nerve Root ◽  
Lumbar Mri

Far lateral lumbar disc extrusion: MRI findings and surgical treatment

2013 ◽  
Vol 26 (04) ◽  
pp. 318-322 ◽  
Author(s):  
J. Lang ◽  
F. Forterre ◽  
A. Fadda
Keyword(s):  
Disc Herniation ◽  
Nerve Root ◽  
Spinal Canal ◽  
Clinical Signs ◽  
Mri Findings ◽  
Lateral Extrusion ◽  
Lumbar Nerve Root ◽  
Disc Material ◽  
Far Lateral ◽  
Lateral Disc Herniation

SummaryThis case report describes the magnetic resonance imaging (MRI) findings and the treatment of a far lateral extrusion of disc material at the sixth and seventh lumbar vertebrae (L6-L7) in a five-year-old male Alpine Dachsbracke dog referred to our hospital for investigation of the complaint of a one week progressive lameness in the left pelvic limb and poorly localized back pain. An extra-foraminal left lateral disc herniation impinging on the sixth lumbar nerve root was diagnosed by MRI examinations. Due to the far lateral position of the extruded disc material on MRI, surgical opening of the spinal canal was not necessary. Removal of the herniated soft disc material impinging on the L6 nerve root, and fenestration of the L6-L7 disc was performed laterally. To the author’s knowledge ‘far-lateral’ disc herniation beyond the neuroforamen without any spinal canal contact has not been described in dogs until now. A complete recovery with no evidence of pain was achieved only after a couple of weeks after surgery. We acknowledge that it is possible that other pathological mechanisms may have contributed to clinical signs and to a delayed recovery.

scholarly journals Ligamentum Flavum Hematoma Associated with L5–S1 Pars Interarticularis Defect: A Case Report and Review of the Literature

2020 ◽  
Author(s):  
Kenan Kıbıcı ◽  
Berrin Erok ◽  
Ahmet Çolak
Keyword(s):  
Nerve Root ◽  
Ligamentum Flavum ◽  
Histopathological Examination ◽  
Clinical Manifestations ◽  
Spinal Instability ◽  
Surgical Removal ◽  
Nerve Root Compression ◽  
Left Posterior ◽  
Pars Interarticularis ◽  
Magnetic Resonance Imaging Mri

AbstractLigamentum flavum hematoma (LFH) is an extremely rare compressive epidural lesion of the spine. The clinical manifestations of LFH are similar to that caused by other more common pathologies of nerve root compression like disc herniation. In the diagnosis, magnetic resonance imaging (MRI) is very important but challenging due to the changing intensities of the hematoma in relation to the stages of the aging blood. Herein, we report a case of LFH compressing the spinal canal in a 60-year-old man with pars interarticularis defect. He presented with low back pain radiating to the left leg. The neurological examination was consistent with left S1 nerve root compression. The MRI revealed a left posterior epidural mass compressing the thecal sac and S1 nerve root at the left L5–S1 level near the pars interarticularis defect. After surgical removal of the lesion, histopathological examination confirmed the diagnosis of LFH. Following surgery, he recovered rapidly. LFH due to spinal instability is important in terms of the understanding of the pathophysiological mechanisms related with LFH.

scholarly journals Partial Facetectomy for Lumbar Foraminal Stenosis

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Kevin Kang ◽  
Juan Carlos Rodriguez-Olaverri ◽  
Frank Schwab ◽  
Jenifer Hashem ◽  
Afshin Razi ◽  
...  
Keyword(s):  
Nerve Root ◽  
Functional Limitations ◽  
Effective Means ◽  
Neurogenic Claudication ◽  
Spinal Instability ◽  
Foraminal Stenosis ◽  
Lumbar Foraminal Stenosis ◽  
Additional Surgery ◽  
Lumbar Nerve Root ◽  
Failed Back Surgery

Background. Several different techniques exist to address the pain and disability caused by isolated nerve root impingement. Failure to adequately decompress the lumbar foramen may lead to failed back surgery syndrome. However, aggressive treatment often causes spinal instability or may require fusion for satisfactory results. We describe a novel technique for decompression of the lumbar nerve root and demonstrate its effectiveness in relief of radicular symptoms.Methods. Partial facetectomy was performed by removal of the medial portion of the superior facet in patients with lumbar foraminal stenosis. 47 patients underwent the procedure from 2001 to 2010. Those who demonstrated neurogenic claudication without spinal instability or central canal stenosis and failed conservative management were eligible for the procedure. Functional level was recorded for each patient. These patients were followed for an average of 3.9 years to evaluate outcomes.Results. 27 of 47 patients (57%) reported no back pain and no functional limitations. Eight of 47 patients (17%) reported moderate pain, but had no limitations. Six of 47 patients (13%) continued to experience degenerative symptoms. Five of 47 patients (11%) required additional surgery.Conclusions. Partial facetectomy is an effective means to decompress the lumbar nerve root foramen without causing spinal instability.

Posterior Surgical Approach to the Cervical Neural Foramen for Intervertebral Disc Disease

Neurosurgery ◽  
2004 ◽  
Vol 54 (3) ◽  
pp. 662-666 ◽  
Author(s):  
Stephen M. Russell ◽  
Vallo Benjamin
Keyword(s):  
Surgical Technique ◽  
Surgical Approach ◽  
Nerve Root ◽  
Foraminal Stenosis ◽  
Nerve Root Compression ◽  
Pathological Anatomy ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Neural Foramen ◽  
Posterior Foraminotomy

Abstract A POSTERIOR FORAMINOTOMY (hemilaminotomy and medial facetectomy) is indicated for the treatment of nerve root compression secondary to posterolateral disc herniation or spondylotic foraminal stenosis. We describe the normal and pathological anatomy of the cervical neural foramen as well as our surgical technique, which has been highly effective in cases of cervical discogenic radiculopathy.

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