• Manabu Sasaki, Masanori Aoki, and Toshiki Yoshimine.
• Department of Neurosurgery and Spine Surgery, Yukioka Hospital, Japan.
• No Shinkei Geka. 2010 May 1;38(5):477-83.

AbstractLumbar canal stenosis (LCS) and lumbar foraminal stenosis (LFS) are frequently observed in elder patients. For patients with radiculopathy caused by both LCS and LFS, surgical manipulations require nerve root decompression from its exit zone to the lateral part of the vertebral foramen, and often need spinal instrumentation. In the present report, we performed a new strategy of surgical decompression without spinal fixation. An 81-year-old woman suffered from bilateral buttock pain, left leg pain and right leg numbness in the L4 and L5 nerve root distribution. MRI and CT scans showed LCS at L3-5 levels and left LFS at L4-5 level. Although the L5 radiculopathy diminished with conservative treatment for 3 weeks, she could not walk due to residual L4 radiculopathy. We tried to perform surgical decompression as follows; the left L4 nerve root was decompressed by lateral fenestration on the left L4 lamina and simultaneously by bilateral spinal canal decompression through right laminotomy for LCS. This method can achieve decompression of the left L4 nerve root from the spinal canal to the vertebral foramen under direct observation while preserving the continuity of the lamina. The patient was relieved from the radicular pain after the operation, and returned to her previous activity of daily living. One-year after the operation, she was free from the radiculopathy, and radiograms showed no fracture in the preserved left L4 lamina. Lateral fenestration combined with bilateral spinal canal decompression through contralateral laminotomy is potentially a surgical option for radiculopathy caused by both LSC and LFS.

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