Lateral Recess Stenosis

What is Lateral Recess Stenosis?

Stenosis refers to the abnormal narrowing of any passage anywhere in the body. Spinal stenosis occurs within the spinal region.

The spinal column is composed of 33 individual vertebrae, these bones are stacked upon one another, rather like building blocks; they have the function of supporting the weight of the body and head, allowing movement and protecting the spinal cord, which runs from the brain to the lower back. Along its course there are various openings at which nerves exit the spinal cord to transmit signals and messages from the brain to the rest of the body.

These openings lie between the vertebrae, as the nerves exit the spinal column they pass through a cylindrical opening, this bony tubular channel is known as the lateral recess, from the lateral recess the nerves pass through an opening known as the foramen, before branching off into the body.

In most individuals there is adequate space for the spinal cord inside the spinal canal and for the exiting nerves. Spinal stenosis occurs when symptoms of other conditions, such as a bulging disc or bone growth spurts constrict the space for the nerves or spinal cord.

Lateral recess stenosis is defined as the narrowing of the sides of the bony tubular passageway, the lateral recess. This narrowing causes a loss of space which may result in pressure on the exiting nerve, causing a range of different symptoms. Insignificant narrowing may also occur where no symptoms are presented.

Causes

Most forms of spinal stenosis are generally associated with degenerative age related conditions such as the following:

  • Disc Related Problems
    • bulging disc
    • disc herniation
    • degenerative disc disease

Disc related problems often occur when a crack or tear in the hard outer exterior of the disc allows the nucleus, a jelly like substance, to spill out and protrude onto surrounding tissue, this often compresses nearby nerves. As we age, our discs begin to dry out and therefore start to shrink, the lack of moisture can leave them more prone to herniation. A herniated disc may cause a loss of space in the lateral recess, resulting in the nerve roots being either pinched or squeezed.

  • Facet Disease and Osteoarthritis (bone spurs)

Facet disease is essentially caused by osteoarthritis; the facet joints which are located on the spinal column, become painful and swollen and over time, the cartilage and fluid that lubricate the joints eventually wears away completely, leaving bone rubbing on bone. This stimulates the vertebrae to produce more bone as a form of protection, bony spurs grow around the facet joint. These bony spurs protrude outwards and can cause stenosis, ultimately resulting in pressure on the nerves.

  • Spondylolisthesis

This occurs in the lower back when a vertebrae slips out of place, pressing on exiting nerves.

  • Other

Other more unusual causes include, congenital stenosis, this occurs when a patient is born with a smaller sized canal. Other rarer causes include tumours or other types of disease.

Symptoms

Lateral recess stenosis one of the most common forms of spinal stenosis and occurs more frequently in the lumbar (lower) region of the back. Patients may experience some local pain in the affected region, however in many cases sciatic like symptoms are felt, where referred pain radiates to other parts of the body. Symptoms are frequently felt into the buttocks and legs, where the patient may experience, pain, weakness, tingling or numbness. Some patients report symptoms of heaviness in the legs and a difficulty walking, these symptoms are easy to confuse with muscular pain.

Diagnosis

Investigation into lateral recess stenosis will usually consist of a thorough medical examination with close attention paid to the symptoms and a detailed medical history of the patient. For further diagnosis an MRI scan may be useful to help identify changes to soft tissue such as the intervertebral discs. A CT scan may illustrate changes in bone growth, such as bony spurs caused by osteoarthritis.

Treatment

Treatment will very much depend on the diagnosis and the cause of the lateral recess stenosis. Conservative medical treatment, utilising non-surgical forms of treatment is usually the first step. Conservative treatment includes the use of medication, physiotherapy and in some cases, a form of psychological treatment to help patients cope with their symptoms. Pain management clinics usually offer a combination of the above treatments, tailoring treatment methods to suit the individual patient’s needs.

Pain relief medication may include one or more of the following:

  • over the counter analgesics and anti-inflammatory drugs NSAIDs
  • prescription only painkillers such as opiods
  • anti-convulsant
  • anti-depressant
  • injections of corticosteroid and anaesthetic

If conservative methods fail to relieve symptoms and there is a certain diagnosis, then surgery may be an option. Depending on the cause and the overall assessment of the patient, either conventional open surgery, which carries its own risks; excessive bleeding, infection, or an adverse reaction to the anaesthetic, or another alternative is endoscopic minimally invasive spinal surgery. Either of the two types of surgery may be considered.

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