Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Department of Neurosurgery, Muhimbili Orthopaedic and Neurosurgical Institute, Dar es Salaam, Tanzania.
Department of Orthopaedic Surgery, Japanese Red Cross Kagoshima Hospital, Kagoshima, Japan.
World Neurosurg. 2019 Jul;127:464-468. doi: 10.1016/j.wneu.2019.04.104. Epub 2019 Apr 19.
Several authors have reported the occurrence of extraforaminal L5 nerve root compression between lumbosacral transitional vertebrae (LSTV) and sacral ala, but reports on a lesion caused by an intervertebral osteophyte on the ventral and contralateral side of a unilateral abnormality by LSTV are hardly available.
A 67-year-old woman presented with pain along the distribution of the L5 nerve root; straight leg raise test, femoral nerve stretch test, and Kemp test were positive on the left. Following plain radiographs, computerized tomography, magnetic resonance imaging, and selective nerve root block, an osteophyte bridging the L5 and S1 vertebral bodies in the ventral side was identified compressing the L5 nerve root. On account of resistance to conservative therapy and the delicate position of the lesion, surgical treatment was performed by an anterior decompression. Subsequently, the patient attained adequate relief from pain and could walk normally.
We herein present a very rare case of extraforaminal L5 nerve root compression caused by an intervertebral osteophyte on the ventral and contralateral side of a unilateral abnormality by LSTV, which was managed by anterior decompression.
多位作者报道了腰骶移行椎（LSTV）与骶骨翼之间发生的椎间孔外 L5 神经根受压，但关于 LSTV 单侧异常的腹侧和对侧椎间骨赘引起的病变的报道却很少。
一名 67 岁女性表现为 L5 神经根分布区疼痛；左侧直腿抬高试验、股神经牵拉试验和 Kemp 试验阳性。行普通 X 线、计算机断层扫描、磁共振成像和选择性神经根阻滞检查后，发现 L5 和 S1 椎体腹侧有一个骨桥，压迫 L5 神经根。由于对保守治疗有抵抗，且病变位置较难处理，故采用前路减压进行手术治疗。随后，患者疼痛得到充分缓解，可以正常行走。
我们在此报告一例非常罕见的由 LSTV 单侧异常的腹侧和对侧椎间骨赘引起的椎间孔外 L5 神经根受压病例，采用前路减压治疗。
