Lateral stenosis

- Discussion:
    - involves impingment of nerve roots lateral to the thecal sac, as they pass thru the neural foramina;
    - anatomically there is compression from medial aspect of hypertrophic superior articular facet,
    - often associated with facet joint arthropathy (superior articular process enlargement) and disc disease;
          - syndrome is made worse w/ hypertrophy of the ligamentum flavum and or joint capsule, and vertebral body osteophyte/disc;
    - foraminal stenosis affects the exiting (upper) nerve root;
    - the intervertebral foramina become progressively smaller from L1 to L5, and therefore, the L5 nerve root tends to become more 
          involved in stensosis than other nerve roots;
    - extraforaminal lateral root compression (far out syndrome)
          - involves L5 root impingement between sacral ala & L5 transverse process and is usually seen in degenerative scoliosis;
          - isthmic spondylolisthesis, or w/ extraforaminal herniated discs;

- Surgical Treatment:
    - involves decompression of of the hypertrophied lamina and ligamentum flavum and parital facetectomy;
          - fusion is necessary if instability is created;
    - nerve root compression can occur at more than one level, and must be completely decompressed to relieve symptoms

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, August 29, 2011 1:54 pm