STUDY DESIGN: A case of unilateral far-out foraminal entrapment of the L5 spinal nerve below a transitional vertebra is presented with a review of the literature. OBJECTIVES: To describe management of a rare far-out foraminal stenosis below a transitional vertebra and to evaluate the surgical procedure and results. SUMMARY OF BACKGROUND DATA: Far-out foraminal stenosis with radiculopathy caused by bony spur formation secondary to anomalous articulation between the transverse process and the sacral ala is rarely reported. Decompression at this point traditionally has been performed through a posterior approach, similar to that performed for the far-out syndrome. There are no previous reports describing anterior decompression through an extraperitoneal approach. METHODS: The diagnosis was confirmed by computed tomography, magnetic resonance imaging, and selective radiculography. Anterior decompression was performed by resecting the bony spur using a wide muscle-splitting extraperitoneal approach. RESULTS: Anterior decompression was performed with minimal intervention to the spine and the trunk muscles. Good relief of low back pain and sciatica was obtained. CONCLUSIONS: Selective radiculography was the method of examination with the optimal diagnostic value for far-out foraminal stenosis. An anterior approach to the decompression of far-out foraminal stenosis below a lumbosacral transitional vertebra is a relatively simple and effective method.
STUDY DESIGN: A case of unilateral far-out foraminal entrapment of the L5 spinal nerve below a transitional vertebra is presented with a review of the literature. OBJECTIVES: To describe management of a rare far-out foraminal stenosis below a transitional vertebra and to evaluate the surgical procedure and results. SUMMARY OF BACKGROUND DATA: Far-out foraminal stenosis with radiculopathy caused by bony spur formation secondary to anomalous articulation between the transverse process and the sacral ala is rarely reported. Decompression at this point traditionally has been performed through a posterior approach, similar to that performed for the far-out syndrome. There are no previous reports describing anterior decompression through an extraperitoneal approach. METHODS: The diagnosis was confirmed by computed tomography, magnetic resonance imaging, and selective radiculography. Anterior decompression was performed by resecting the bony spur using a wide muscle-splitting extraperitoneal approach. RESULTS: Anterior decompression was performed with minimal intervention to the spine and the trunk muscles. Good relief of low back pain and sciatica was obtained. CONCLUSIONS: Selective radiculography was the method of examination with the optimal diagnostic value for far-out foraminal stenosis. An anterior approach to the decompression of far-out foraminal stenosis below a lumbosacral transitional vertebra is a relatively simple and effective method.
Authors: Neil A Porter; Radhesh K Lalam; Bernhard J Tins; Prudencia N M Tyrrell; Jaspreet Singh; Victor N Cassar-Pullicino Journal: Skeletal Radiol Date: 2013-10-25 Impact factor: 2.199