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. 2020 Mar;48(3):300060519884817.
doi: 10.1177/0300060519884817. Epub 2019 Nov 27.

Accurate location and minimally invasive treatment of lumbar lateral recess stenosis with combined SNRB and PTED

Bing Yue  1 , Fang Shen  2 , Zhi-Fang Ye  2 , Ze-Hao Wang  2 , Hui-Lin Yang  1 , Guo-Qiang Jiang  2
Affiliations

Accurate location and minimally invasive treatment of lumbar lateral recess stenosis with combined SNRB and PTED

Bing Yue et al. J Int Med Res. 2020 Mar.

Abstract

Objective: To establish a management strategy for multi-segment lumbar lateral recess stenosis.

Methods: A retrospective study was performed in patients in whom suspected responsible nerve roots underwent sequential selective nerve root block (SNRB). Based on pain remission rate after blocking, the contribution of nerve root compression to symptoms was classified as absolutely (≥70%) or relatively (30-70%) responsible or non-responsible (<30%). Conservative treatment was continued if visual analogue scale (VAS) at 3 days after blocking a single nerve root or VAS at 3 days after blocking multiple nerve roots was ≥50%; otherwise, percutaneous transforaminal endoscopic discectomy (PTED) was performed. Pain and functional scores were evaluated on day 3, 6 months and 1 year after SNRB or PTED.

Results: Fifty-seven of 80 patients had a single absolutely responsible root, 20 had 2 responsible roots, and 3 had 3 responsible roots. Among them, 41, 10, and 1 patient underwent PTED, respectively. Both the PTED and conservative groups improved significantly in VAS remission rate and functional scores compared with admission. Moreover, the PTED group had a better VAS remission rate compared with the conservative group.

Conclusion: A combination of SNRB with PTED was effective for diagnosing and treating multi-segment lumbar lateral recess stenosis.

Keywords: Minimally invasive; diagnosis; lumbar lateral recess stenosis; multi-segment; nerve root block; treatment strategy.

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Conflict of interest statement

Each author certifies that he or she, or a member of his or her immediate family, has no commercial association (i.e., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted manuscript.

Figures

Figure 1.
Figure 1.
Minimally invasive diagnostic and therapeutic strategies for multi-segment lumbar lateral recess stenosis.
Figure 2.
Figure 2.
Typical case: a 68-year-old male patient with pain in the right lower limb, accompanied by restricted walking for 3 years, had aggravated pain for 4 months. A: Lumbar MRI – right sagittal position; B: Lumbar MRI – L3/4 cross-section; C: Lumbar MRI – L4/5 cross-section showed lumbar 3/4, 4/5 right lateral recess stenosis; D: Intraoperative fluoroscopy of L4 nerve root block; E: Intraoperative fluoroscopy of L5 nerve root block; F: Intraoperative fluoroscopy of PTED; G: Complete decompression of the right nerve root of L5 was seen; H: Lumbar CT – right sagittal position; I: Lumbar CT – L3/4 cross-section; J: Lumbar CT – L4/5 cross-section showed removal of most of the right superior articular processes of L4 and L5, and full decompression of the lateral recesses.
See this image and copyright information in PMC

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