Microendoscopic Surgical Treatment for Lumbar Foraminal Stenosis with an Anomalous Lumbosacral Nerve Root: A Case Report

AbstractIn this paper we sought to develop and assess the reproducibility of an updated 6-point grading system for lumbar foraminal stenosis based on the widely used Lee classification that more accurately describes lumbar foraminal stenosis as seen on high-resolution MRI. Grade A indicates absence of foraminal stenosis. Grades B, C, D and E indicate presence of foraminal stenosis with contact of the nerve root with surrounding anatomical structures (on one, two, three or four sides for B, C, D and E respectively) yet without morphological change of the nerve root. To each grade, a number code indicating the location of contact between the nerve root and surrounding anatomical structure(s) is appended. 1, 2, 3 and 4 indicate contact of the nerve root at superior, posterior, inferior and anterior position of the borders of the lumbar foramen. Grade F indicates presence of foraminal stenosis with morphological change of the nerve root. Three readers graded the lumbar foramina of 101 consecutive patients using high-resolution T2w (and T1w) MR images with a spatial resolution of beyond 0.5 mm3. Interreader agreement was excellent (Cohen’s Kappa = 0.866–1). Importantly, 30.6%/31.6%/32.2% (reader 1/reader 2/ reader 3) of foramina were assigned grades that did not appear in the original Lee grading system (grades B and D). The readers found no foramen that could not be described accurately with the updated grading system. Thus, an updated 6-point grading system for lumbar foraminal stenosis is reproducible and comprehensively describes lumbar foraminal stenosis as seen on high-resolution MRI.

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

Journal of Spine Surgery ◽

10.21037/jss-21-63 ◽

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

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Successful visualization of dynamic change of lumbar nerve root compression with the patient in both upright and prone positions using dynamic digital tomosynthesis-radiculography in patients with lumbar foraminal stenosis: An initial report of three cases

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2018.12.016 ◽

2019 ◽

Vol 62 ◽

pp. 256-259 ◽

Cited By ~ 3

Author(s):

Kentaro Mataki ◽

Masao Koda ◽

Yosuke Shibao ◽

Hiroshi Kumagai ◽

Katsuya Nagashima ◽

...

Keyword(s):

Nerve Root ◽

Dynamic Change ◽

Foraminal Stenosis ◽

Digital Tomosynthesis ◽

Nerve Root Compression ◽

Initial Report ◽

Lumbar Foraminal Stenosis ◽

Lumbar Nerve Root

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Percutaneous Endoscopic Lumbar Foraminoplasty for Lumbar Foraminal Stenosis of Elderly Patients with Unilateral Radiculopathy: Radiographic Changes in Magnetic Resonance Images

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0038-1677052 ◽

2019 ◽

Vol 80 (04) ◽

pp. 302-311 ◽

Cited By ~ 1

Author(s):

Jongchul Chung ◽

Changbong Kong ◽

Woosung Sun ◽

Dohyung Kim ◽

Hyungdong Kim ◽

...

Keyword(s):

Magnetic Resonance ◽

Elderly Patients ◽

Nerve Root ◽

Magnetic Resonance Images ◽

Foraminal Stenosis ◽

Cross Sectional ◽

Lumbar Foraminal Stenosis ◽

Before And After ◽

Foraminal Height ◽

Radiographic Changes

Background and Study Aims/Objective Clinical outcomes of percutaneous endoscopic lumbar foraminoplasty (PELF) performed for lumbar foraminal stenosis (LFS) have been reported in the literature. However, no study has reported the radiographic changes in magnetic resonance imaging (MRI) after surgery. This report presents the clinical outcome as well as radiographic changes in MRI after PELF for elderly patients with unilateral radiculopathy. We also describe detailed operative nuances to expand the foraminal space and mobilize the affected nerve root. Material and Methods Between January 2015 and December 2016, 24 patients over 65 years of age underwent PELF to treat unilateral radiculopathy caused by LFS. The demographics, medical history, visual analog scale (VAS), and Oswestry Disability Index (ODI) were reviewed retrospectively. MRI radiographic data, cross-sectional area (CSA) of the affected foramen and nerve root, were evaluated before and after surgery. Results Preoperative radiculopathy improved in 23 of 24 patients (96%). The VAS score significantly improved from 7.89 ± 1.8 to 2.57 ± 2.5 (67.4%). The ODI also significantly improved from 33.15 ± 9.2 to 10.24 ± 6.7 (69.1%). Foraminal width increased ∼ 1.67 mm (21.4%), foraminal height increased 5.00 mm (36.9%), and CSA increased about 55.27 mm2 (60.6%) (p < 0.001). The CSA and the shape of the affected nerve section also expanded, but these were not statistically significant. Conclusion We performed PELF in elderly patients with LFS. There were considerable radiographic changes in MRI, and the patients also showed clinically relevant improvement. Thus PELF resulted in sufficient decompression of the nerve root in LFS.

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Partial Facetectomy for Lumbar Foraminal Stenosis

Advances in Orthopedics ◽

10.1155/2014/534658 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 7

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.

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Successful treatment of unilateral neck pain with transforaminal epidural steroid injection on the left C3 nerve root: a case report

Journal of International Medical Research ◽

10.1177/0300060520969538 ◽

2020 ◽

Vol 48 (11) ◽

pp. 030006052096953

Author(s):

Min Cheol Chang ◽

Mathieu Boudier-Revéret ◽

Ming-Yen Hsiao ◽

Shaw-Gang Shyu

Keyword(s):

Case Report ◽

Neck Pain ◽

Nerve Root ◽

Rating Scale ◽

Steroid Injection ◽

Radicular Pain ◽

Epidural Steroid Injection ◽

Foraminal Stenosis ◽

Transforaminal Epidural Steroid Injection ◽

Epidural Steroid

In clinical practice, neck pain is one of the most common complaints. Although most of the cervical radicular pain is manifested in the neck and upper extremities, C3 or C4 radicular pain only results in neck pain. It does not produce upper extremity radiating pain. This case report describes a 70-year-old male that presented with a numeric rating scale score of 5 out of 10 for the left neck pain that he had been experiencing for the previous 1 month. Hyperalgesia was present on the left C3 dermatome. Foraminal stenosis at the left C2–C3 was observed on cervical magnetic resonance imaging. In order to manage the neck pain on the left side due to the foraminal stenosis at the left C2–C3, a transforaminal epidural steroid injection (TFESI) was undertaken on the left C3 nerve root. Thirty minutes after TFESI, the patient’s neck pain had completely resolved. At the 1-month and 3-month follow-ups, no neck pain was evident. Clinicians should consider the possibility of C3 radicular pain as a cause of neck pain, especially when the neck pain presents as neuropathic pain combined with sensory deficits.

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