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.

scholarly journals Spread of Contrast During L4 and L5 Nerve Root Infiltration Under Fluoroscopic Guidance

2007 ◽  
Vol 3;10 (5;3) ◽  
pp. 461-466
Author(s):  
Dmitri Vassiliev
Keyword(s):  
Nerve Root ◽  
Water Soluble ◽  
Fluoroscopic Guidance ◽  
Lumbar Radiculopathy ◽  
Nerve Roots ◽  
Nerve Root Block ◽  
Significant Difference ◽  
Lumbar Segment ◽  
Nerve Root Blocks ◽  
Selective Nerve Root Block

Background: Lumbar selective nerve root blocks have been performed to establish the origin of lumbar radiculopathy in clinically difficult cases. The diagnostic ability of selective nerve root blocks remains controversial because of concern over potential spread of an injectate onto adjacent structures. Objective: To investigate the spread of different volumes of water-soluble contrast during L4 and L5 selective nerve root blocks. Design: Retrospective, observational case series. Methods: Analysis of medical records and X-ray images obtained during L4 and L5 selective nerve root blocks. Results: During L4 selective nerve root block 1 ml of contrast spread onto L5 nerve roots in 46.1% of subjects and during L5 nerve root block 1 ml of contrast spread onto S1 nerve root in 57.7%. There was statistically significant difference (p<0.0001) between spread of contrast onto the medially located nerve root in the same lumbar segment and nerve roots in the lumbar segment above. Conclusions: Injection of 1 ml of contrast under fluoroscopic guidance does not guarantee selective spread of the contrast around L4 or L5 nerve roots only. There is also spread toward the more medial nerve root in the same spinal segment during L4 and L5 nerve root infiltration. These findings suggest that it is possible to differentiate between L4 and L5 nerve root pathology using a sequential nerve root blocks under fluoroscopic guidance. Key words: Selective nerve root block, Lumbar radiculopathy, Fluoroscopic guidance

scholarly journals TECHNICAL CONSIDERATIONS IN USING A MODIFIED OUTSIDE-IN TRANSFORAMINAL ENDOSCOPIC DISCECTOMY APPROACH IN OVERCOMING LATERAL RECESS STENOSIS: A CASE STUDY

2017 ◽  
pp. 167-173
Author(s):  
Matthew Skoblar
Keyword(s):  
Scar Tissue ◽  
Endoscopic Approach ◽  
Foot Drop ◽  
Lumbar Disk Herniation ◽  
Lateral Recess ◽  
Endoscopic Techniques ◽  
Lateral Recess Stenosis ◽  
Initial Surgery ◽  
Endoscopic Discectomy ◽  
Bull's Eye

Microsurgery is a well-established and defi nitive surgical intervention performed for symptomatic radiculopathy secondary to lumbar disk herniation. While midline and paramedian Wiltse approaches have been the standard for lumbar nerve decompression, advances in neuroendoscopic instrumentation and visualization have broadened the ability of transforaminal endoscopic treatment to resect pathology in more challenging locations. Flexible instruments can be used to reach herniations in the epidural space as far centrally as the mid-vertebral body and enable physicians to reach cranially or caudally migrated sequestrations. Reviews of decompressive lumbar radiculopathy surgery have stated that there is equal effi cacy when comparing the transforaminal endoscopic technique to standard microdiscectomy. However, questions have been posed by some authors in the literature regarding the utility of the endoscopic techniques with regard to patients with concomitant lateral recess stenosis and neurologic defi cits. The authors present a case of an endoscopically resected lumbar reherniated extrusion causing lateral recess stenosis and foot drop. The endoscopic approach is performed in an awakened patient with the use of local anesthetic. The optimal technique is described, including the use of the target, or bull’s eye, view fl uoroscopically to allow for enhanced accuracy when positioning the endoscopic working channel, as well as to allow for an increase in the intraforaminal space. The bull’s eye approach is a more intuitive technique for placement of the endoscopic working channel for pain physicians as they are accustomed to navigating the foramen in this view. The use of an endoscopic approach with the initial surgery also allowed for the creation of minimal scar tissue, minimizing reoperative complication risks. The author’s technique may offer a signifi cant advantage in overcoming diffi culties with lateral recess stenosis described in the literature and allow for more precise placement of the endoscope, particularly for pain physicians. Key words: Endoscopic transforaminal discectomy, lateral recess stenosis, reherniation

Thoracic Epidural and Nerve Root Injections: Fluoroscopy

2016 ◽  
Author(s):  
Jianguo Cheng
Keyword(s):  
Nerve Root ◽  
Small Volume ◽  
Epidural Block ◽  
Nerve Roots ◽  
Nerve Root Block ◽  
Thoracic Epidural ◽  
Thoracic Nerve ◽  
Transforaminal Approach ◽  
Nerve Root Blocks ◽  
Selective Nerve Root Block

Thoracic nerve root blocks can be achieved by interlaminal epidural, transforaminal epidural, paravertebral, and selective nerve root injections. The interlaminal approach allows blocking multiple nerve roots bilaterally, while the transforaminal approach has the advantage of depositing the injectate primarily to the anterior epidural space on the side of the injection, closer to the pathology. The paravertebral approach is often used to block multiple nerve roots on the side of injection, and the selective nerve root block is used to target a specific nerve root using a small volume of injectate. Fluoroscopy-guided injection the most commonly used technique. Contrast materials are often used to confirm the appropriate needle placement and monitor the spread of the injectate. Thoracic nerve root block and transforaminal epidural block are perceived as technically demanding due to anatomic complexity of the thoracic spine, its proximity to the lungs and major vasculature, and potential complications.

scholarly journals Utility of diffusion tensor imaging for guiding the treatment of lumbar disc herniation by percutaneous transforaminal endoscopic discectomy

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Jiaqi Li ◽  
Hao Cui ◽  
Zhipeng Liu ◽  
Yapeng Sun ◽  
Fei Zhang ◽  
...  
Keyword(s):  
Nerve Root ◽  
Diffusion Tensor ◽  
Lumbar Disc ◽  
Lateral Nerve ◽  
Nerve Roots ◽  
Nerve Root Injury ◽  
Post Surgery ◽  
Root Injury ◽  
Significant Difference ◽  
Endoscopic Discectomy

AbstractThe purpose of this study was to evaluate the utility of diffusion tensor imaging (DTI) for guiding the treatment of lumbar disc herniation (LDH) by percutaneous transforaminal endoscopic discectomy (PTED). We collected the clinical data of a total of 19 patients: 10 with unilateral S1 nerve root injury, 6 with unilateral L5 nerve root injury, and 3 with unilateral L5 and S1 nerve root injury. All patients underwent DTI before surgery, 3 days post-surgery, 30 days post-surgery, and 90 days post-surgery. The comparison of the fractional anisotropy (FA) values of compressed lateral nerve roots before surgery and 3, 30, and 90 days post-surgery demonstrated the recovery of nerve roots to be a dynamic process. A significant difference was found in the FA values between compressed lateral nerve roots preoperatively and normal lateral nerve roots before surgery, 3 days post-surgery and 30 days post-surgery (p < 0.05). There was no significant difference in FA values between compressed lateral nerve roots and normal ones 90 days post-surgery (p > 0.05). DTI can be used for the accurate diagnosis of LDH, as well as for postoperative evaluation and prognosis, and it is thus useful for the selection of surgical timing.

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.

Conjoined lumbosacral nerve roots

1981 ◽  
Vol 55 (4) ◽  
pp. 585-589 ◽  
Author(s):  
Joseph A. Epstein ◽  
Robert Carras ◽  
Jose Ferrar ◽  
Roger A. Hyman ◽  
Arfa Khan
Keyword(s):  
Water Soluble ◽  
Herniated Disc ◽  
Uneventful Recovery ◽  
Nerve Roots ◽  
Content Type ◽  
Lateral Recess ◽  
Anatomical Changes ◽  
Lateral Recess Stenosis ◽  
Herniated Discs ◽  
Adequate Decompression

✓ Anomalous L-5 and S-1 nerve roots occur infrequently. If not properly recognized, surgery for entrapment disorders may result in serious neural injury because of an improper surgical approach in exposure and in removing the underlying herniated discs. The diagnosis has been made preoperatively since the introduction of water-soluble myelography because of improved filling of the nerve roots. A herniated disc beneath the bifid root causes extreme pain and disability with marked signs of entrapment because of firm fixation of the conjoined root in the lateral recess between the two pedicles. An underlying herniated disc may not be recognized because of the unique anatomical changes. To properly identify the nature of the lesion, wide exposure by hemilaminectomy is preferred, with unroofing of the lateral recesses and wide foraminal decompression. Eight such patients are reported: seven had herniated discs, and one had lateral recess stenosis with superior facet entrapment. With adequate decompression, all patients made a rapid, uneventful recovery.

Prompt Return to Work after Bilateral Transforaminal Full-endoscopic Lateral Recess Decompression under Local Anesthesia: A Case Report

2020 ◽  
Author(s):  
Kosuke Sugiura ◽  
Kazuta Yamashita ◽  
Hiroaki Manabe ◽  
Yoshihiro Ishihama ◽  
Fumitake Tezuka ◽  
...  
Keyword(s):  
Return To Work ◽  
Local Anesthesia ◽  
Skin Incision ◽  
Leg Pain ◽  
Lateral Recess ◽  
Canal Stenosis ◽  
Transforaminal Approach ◽  
Lateral Recess Stenosis ◽  
Lumbar Spinal ◽  
Herniated Nucleus Pulposus

AbstractTransforaminal full-endoscopic lumbar diskectomy became established early in the 21st century. It can be performed under local anesthesia and requires only an 8-mm skin incision, making it the least invasive disk surgery method available. The full-endoscopic technique has recently been used to treat lumbar spinal canal stenosis. Here, we describe the outcome of simultaneous bilateral decompression of lumbar lateral recess stenosis via a transforaminal approach under local anesthesia in a 60-year-old man. The patient presented with a complaint of bilateral leg pain that was preventing him from standing and walking, and he had been able to continue his work as a dentist by treating patients while seated. Imaging studies revealed bilateral lumbar lateral recess stenosis with central herniated nucleus pulposus at L4/5. We performed simultaneous bilateral transforaminal full-endoscopic lumbar lateral recess decompression (TE-LRD) under local anesthesia. Both decompression and diskectomy were successfully completed without complications. Five days after TE-LRD, he was able to return to work, and 3 months after the surgery, he resumed playing golf. Full-endoscopic surgery under local anesthesia can be very effective in patients who need to return to work as soon as possible after surgery.

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