Foraminal stenosis of the lumbar spine: a review of 65 surgical cases

This study provides clinical and radiographic information and characteristics that may best define the presence of significant lumbar foraminal stenosis and reports on the outcome of surgical intervention. Although anatomy of the lumbar intervertebral foramen (including static and dynamic pathologic compression of the exiting nerve root) has been described, few studies have focused on the clinical and radiographic features of foraminal stenosis requiring surgical intervention. We retrospectively studied 65 patients with lumbar foraminal stenosis for presenting clinical and radiographic features and intraoperative findings. Symptoms included leg and back pain (100%), paresthesias (45%), and subjective weakness (31%). Examination revealed lumbar tenderness (71%), limited lumbar extension (57%), focal motor weakness (48%), and positive tension signs (42%). The L5 nerve root was most often involved (75%). Almost 50% of patients had already undergone spinal decompression surgery. Surgical procedures included laminectomy and foraminotomy (52 patients) and laminotomy and foraminotomy (23 patients). A concomitant arthrodesis was performed in 63 patients. There were 29 excellent, 25 good, 6 fair, and 5 poor results based on a modified outcome scale at 32.5-month follow-up. Findings suggest that foraminal stenosis is a frequent cause of persistent symptoms after surgery, is most common at the lumbosacral junction, is best identified on parasagittal magnetic resonance images or on images reconstructed with computed tomography, and may be static or dynamic in etiology.