Abe E, Sato K, Shimada Y, Okada K, Yan K, Mizutani Y
Department of Orthopaedic Surgery, Akita University School of Medicine, Japan.
Spine (Phila Pa 1976). 1997 Apr 1;22(7):823-6. doi: 10.1097/00007632-199704010-00023.
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.
To describe management of a rare far-out foraminal stenosis below a transitional vertebra and to evaluate the surgical procedure and results.
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.
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.
Anterior decompression was performed with minimal intervention to the spine and the trunk muscles. Good relief of low back pain and sciatica was obtained.
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.
本文报告了1例过渡椎下方L5脊神经单侧远外侧椎间孔卡压病例，并对相关文献进行了综述。
描述过渡椎下方罕见的远外侧椎间孔狭窄的治疗方法，并评估手术过程及结果。
由横突与骶骨翼异常关节形成继发骨赘导致的伴有神经根病的远外侧椎间孔狭窄鲜有报道。传统上，此部位减压通过后路进行，类似于远外侧综合征的手术方式。此前尚无通过腹膜外入路进行前路减压的报道。
通过计算机断层扫描、磁共振成像和选择性神经根造影确诊。采用广泛肌肉劈开的腹膜外入路切除骨赘进行前路减压。
前路减压对脊柱和躯干肌肉的干预最小。腰背痛和坐骨神经痛得到明显缓解。
选择性神经根造影是对远外侧椎间孔狭窄具有最佳诊断价值的检查方法。腰骶部过渡椎下方远外侧椎间孔狭窄的前路减压是一种相对简单有效的方法。
