The Hip - book
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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