Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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The Triple Entrapment Syndrome of the 5th Lumbar Spinal Nerve

  • Jang, Jee-Soo (Department of Neurosurgery, Gimpo Airport Wooridul Spine Hospital) ;
  • Lee, Sang-Ho (Department of Neurosurgery, Gimpo Airport Wooridul Spine Hospital)
  • Published : 2005.04.30
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Abstract

Objective: The 5th lumbar spinal nerve can be entrapped in the intraspinal zone, foraminal zone, and the extraforaminal zone simultaneously. The failure to recognize that the nerve root can be compressed in such manners may be the reason of a number of failures of surgical decompression. Here we describe a microsurgical method for the decompression of the triple entrapment of the L5 spinal nerve in 21 patients. Methods: Clinical manifestations and surgical results of twenty-one patients treated surgically under the diagnosis of the triple entrapment of the L5 spinal nerve were reviewed retrospectively. All patients were treated by the posterior midline approach for the intraspinal entrapment and by the paraspinal approach for the foraminal and the extraforaminal entrapment. Results: Pain relief was obtained in all patients immediately after surgery. The mean follow-up period after the surgery was 13 months, ranged from 6 to 24 months. The mean Numeric Rating Scale (pain score) improved from 8.9 before the surgery to 1.4 (P<0.0001). The mean ODI scores improved from 76.2 before the surgery to 13.1 (P<0.0001). Nineteen patients were satisfied with their result at the last follow-up examination. Neither complications related to the surgery, nor the spinal instability was detected. Conclusion: The triple entrapment of the 5th lumbar spinal nerve is an important pathologic entity to identify for the treatment of L5 radiculopathy. Combined medial and lateral approaches are safe, minimally invasive and it provide the complete decompression of triple entrapment of the L5 spinal nerve without causing secondary instability like after complete facetectomy.

Keywords

References

  1. Abdullah AF, Ditto EW, Byrd EB, Williams R : Extreme lateral lumbar disc herniations. Clinical syndrome and special problems of diagnosis. J Neurosurg 41 : 229-234, 1974 https://doi.org/10.3171/jns.1974.41.2.0229
  2. Baba H, Uchida K, Maezawa Y, Furusawa N, Okumura Y, Imura S : Microsurgical nerve root canal widening without fusion for lumbosacral intervertebral foraminal stenosis: technical notes and early results. Spinal Cord 34 : 644-650, 1996 https://doi.org/10.1038/sc.1996.116
  3. Burton CV, Kirkaldy-Willis WH, Young-Hing K, Heithoff KB : Causes of failure of surgery on the lumbar spine. Clin Orthop Rel Res 157 : 191-199, 1981
  4. Daltroy LH, Cats-Baril WL, Katz JN, Fossel AH, Liang MH : The North America Spine Society Lumbar Spine Outcome Assessment Instrument : reliability and validity. Spine 21 : 741-749, 1996 https://doi.org/10.1097/00007632-199603150-00017
  5. Fairbank JC, Couper J, Davies JB, O'Brien JP : The Oswestry low back pain disability questionnaire. Physiotherapy 66 : 271-273, 1980
  6. Garrido E, Connaughton PN : Unilateral facetectomy approach for lateral lumbar disc herniation. J Neurosurg 74 : 754-756, 1991 https://doi.org/10.3171/jns.1991.74.5.0754
  7. Gioia G, Mandelli D, Capaccioni B, Randelli F, Tessari L : Surgical treatment of far lateral lumbar disc herniation : Identification of compressed root and discectomy by lateral approach. Spine 24 : 1952- 1957, 1999 https://doi.org/10.1097/00007632-199909150-00015
  8. Hasegawa T, An H, Haughton V, Nowicki B : Lumbar foraminal stenosis : Critical heights of the intervertebral discs and foramina. J Bone Joint Surg 77A : 32-38, 1995
  9. Jenis LG, An HS : Spinal update. Lumbar foraminal stenosis. Spine 25 : 389-394, 2000 https://doi.org/10.1097/00007632-200002010-00022
  10. Jensen MP, Karoly P, O'Riordan EF, Bland F Jr, Burns RS : The subjective experience of actual pain : An assessment of the utility of 10 indices. Clin J Pain 5 : 153-159, 1989 https://doi.org/10.1097/00002508-198906000-00005
  11. Kunogi J, Hasue M : Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine 16 : 1312-1320, 1991 https://doi.org/10.1097/00007632-199111000-00012
  12. Lee CK, Rauschning W, Glenn W : Lateral lumbar spinal canal stenosis : classification, pathologic anatomy, surgical decompression. Spine 13 : 313-320, 1988 https://doi.org/10.1097/00007632-198803000-00015
  13. MacNab I : Negative disc exploration : An analysis of the causes of nerve root involvement in sixty-eight patients. J Bone Joint Surg 53A : 891-903, 1971
  14. Maroon JC, Kopitnik TA, Schulhof LA, Abla A, Wilberger JE : Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine. J Neurosurg 72 : 378-382, 1990 https://doi.org/10.3171/jns.1990.72.3.0378
  15. Matsumoto M, Chiba K, Nojiri K, Ishikawa M, Toyama Y, Nishikawa Y: Extraforaminal entrapment of the fifth lumbar spinal nerve by osteophytes of the lumbosacral spine : anatomical study and a report of four cases. Spine 27 : E169-E173, 2002 https://doi.org/10.1097/00007632-200203150-00020
  16. Muller A, Reulen HJ : A paramedian tangential approach to lumbosacral extraforaminal disc herniations. Neurosurgery 43 : 854-861, 1998 https://doi.org/10.1097/00006123-199810000-00077
  17. Nathan H, Weizenbluth M, Halperin N : The lumbosacral ligament(LSL) with special emphasis on the ' lumbosacral tunnel' and the entrapment of the fifth lumbar nerve. Int Orthop 6 : 197-202, 1982 https://doi.org/10.1007/BF00267730
  18. Olsewski JM, Simmons EH, Kallen FC, Mendel FC : Evidence from cadavers suggestive of entrapment of fifth lumbar spinal nerves by lumbosacral ligaments. Spine 16 : 336-347, 1991 https://doi.org/10.1097/00007632-199103000-00014
  19. Roh SW, Rhim SH : Paramedian tangential approach for the lumbosacral extraforaminal disc herniations. J Korean Neurosurg Soc 28 : 1299- 1304, 1999
  20. Transfeldt EE, Robertson D, Bradford DS : Ligaments of the lumbosacral spine and their role in possible extraforaminal spinal nerve entrapment and tethering. J Spinal Disord 6 : 507-512, 1993 https://doi.org/10.1097/00002517-199306060-00006
  21. Wiltse LL, Spencer CW : New uses and refinements of the paraspinal approach to the lumbar spine. Spine 13 : 696-706, 1988 https://doi.org/10.1097/00007632-198813060-00019