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Iwasaki M, Akiyama M, Koyanagi I, et al. Double Crush of L5 Spinal Nerve Root due to L4/5 Lateral Recess Stenosis and Bony Spur Formation of Lumbosacral Transitional Vertebra Pseudoarticulation: A Case Report and Review. NMC Case Rep J. 2017;4(4):121-125doi: 10.2176/nmccrj.cr.2016-0308.
Iwasaki, M., Akiyama, M., Koyanagi, I., Niiya, Y., Ihara, T., & Houkin, K. (2017). Double Crush of L5 Spinal Nerve Root due to L4/5 Lateral Recess Stenosis and Bony Spur Formation of Lumbosacral Transitional Vertebra Pseudoarticulation: A Case Report and Review. NMC case report journal, 4(4), 121-125. https://doi.org/10.2176/nmccrj.cr.2016-0308
Iwasaki, Motoyuki, et al. "Double Crush of L5 Spinal Nerve Root due to L4/5 Lateral Recess Stenosis and Bony Spur Formation of Lumbosacral Transitional Vertebra Pseudoarticulation: A Case Report and Review." NMC case report journal vol. 4,4 (2017): 121-125. doi: https://doi.org/10.2176/nmccrj.cr.2016-0308
Iwasaki M, Akiyama M, Koyanagi I, Niiya Y, Ihara T, Houkin K. Double Crush of L5 Spinal Nerve Root due to L4/5 Lateral Recess Stenosis and Bony Spur Formation of Lumbosacral Transitional Vertebra Pseudoarticulation: A Case Report and Review. NMC Case Rep J. 2017 Sep 15;4(4):121-125. doi: 10.2176/nmccrj.cr.2016-0308. eCollection 2017 Oct. PMID: 29018654; PMCID: PMC5629357.
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NMC Case Rep J. 2017 Sep 15;4(4):121-125. doi: 10.2176/nmccrj.cr.2016-0308. eCollection 2017 Oct.

Double Crush of L5 Spinal Nerve Root due to L4/5 Lateral Recess Stenosis and Bony Spur Formation of Lumbosacral Transitional Vertebra Pseudoarticulation: A Case Report and Review.

NMC case report journal

Motoyuki Iwasaki, Masahiko Akiyama, Izumi Koyanagi, Yoshimasa Niiya, Tatsuo Ihara, Kiyohiro Houkin

Affiliations

  1. Neurosurgical Department, Otaru General Hospital, Otaru, Hokkaido, Japan.
  2. Spine Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
  3. Hokkaido Neurosurgical Memorial Hospital, Sapporo, Hokkaido, Japan.
  4. Department of Neurosurgery, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.

PMID: 29018654 PMCID: PMC5629357 DOI: 10.2176/nmccrj.cr.2016-0308

Abstract

We present a case of double-crushed L5 nerve root symptoms caused by inside and outside of the spinal canal with spur formation of the lumbosacral transitional vertebra (LSTV). A 78-year-old man presented with 7-year history of moderate paresis of his toe and left leg pain when walking. Magnetic resonance imaging (MRI) revealed spinal stenosis at the L3/4 and 4/5 spinal levels and he underwent wide fenestration of both levels. Leg pain disappeared and 6-min walk distance (6MWD) improved after surgery, however, the numbness in his toes increased and 6MWD decreased 9 months after surgery. Repeated MR and 3D multiplanar reconstructed computed tomography (CT) images showed extraforaminal impingement of the L5 root by bony spur of the left LSTV. He underwent second decompression surgery of the L5/S via the left sided Wiltse approach, resulting in the improvement of his symptoms. The impingement of L5 spinal nerve root between the transverse process of the fifth lumbar vertebra and the sacral ala is a rare entity of the pathology called "far-out syndrome (FOS)". Especially, the bony spur formation secondary to the anomalous articulation of the LSTV (LSPA) has not been reported. These articulations could be due to severe disc degeneration, following closer distance and contact between the transverse process and the sacral ala. To our knowledge, this is the first report describing a case with this pathology and may be considered in cases of failed back surgery syndromes (FBSS) of the L5 root symptoms.

Keywords: double crush; failed back surgery syndrome; far-out syndrome; lumbosacral transitional vertebra; pseudoarticulation

Conflict of interest statement

Conflicts of Interest Disclosure None of the authors has any potential conflict of interest.

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