Lateral Recess Narrowing: Everything You Need To Know!
Understanding Left or Right Lateral Recess Narrowing Caused By Broad-Based Disk Protrusion At Lumbar L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1 Segments.
What is Lateral Recess?
Lateral recess is cylindrical opening surrounded by bony tube that projects out from spinal canal of vertebral column. There are two lateral recesses right and left at each level. Spinal nerve passes through lateral recess to peripheral tissue and organs.
What is Vertebral Column?
Vertebral column is also known as Spinal column. Spinal cord lies in middle of the cylindrical tube known as spinal canal. Vertebral column is formed by 33 vertebrae. Vertebral column is divided in 5 sections, identified as cervical (7 vertebrae), thoracic (12 vertebrae), lumbar (5 vertebrae), sacral (5 vertebrae) and coccyx (4 vertebrae) segments.
What is Spinal Canal?
Brain and brain stem continues as pons, medulla and spinal cord. Spinal cord travels from neck to sacrum through cylindrical spinal canal. Spinal canal is a cylindrical space that runs from base of skull to tail bone. Tailbone is also known as coccyx. Spinal canal is covered by bony vertebral column, which protects spinal cord.
What Is Spinal Cord?
Spinal cord is a bundle of nerves that connects brain to peripheral tissue. Nerve passes up and down within the spinal cord. Nerve passes from brain to peripheral organ and from peripheral organ to brain. Spinal cord gives out a division of nerve at each segment known as spinal nerve. Spinal nerve passes through lateral recess.
How Many Spinal Nerves Branch Out From Spinal Cord?
The spinal cord gives 8 cervical (neck) nerves, 12 thoracic nerves, 5 lumbar nerves, 5 sacral nerves and 1 coccygeal nerve. Spinal cord ends as a cord at second lumbar vertebra and breaks into several branches of nerve known as cauda equina. Cauda equina is a bundle of spinal nerves that consist of nerves from lumbar 3 to 5 nerves, sacral 1 to 5 nerves and coccygeal 1 nerve.
What Is Lateral Recess Narrowing?
Lateral Recess Narrowing is a narrowing of bony tubular channel. Nerve passes through the lateral recess. Narrowing could be insignificant or significant.
What Is Insignificant Lateral Recess Narrowing?
Insignificant narrowing causes minimum or no symptoms. It also causes irritation of the nerve.
What Is Significant Lateral Recess Narrowing?
Significant narrowing of lateral recess is also known as foraminal stenosis. Significant narrowing causes severe pressure on nerve by compressing the nerve from all direction. Significant narrowing results in ischemic changes of nerve. Ischemic changes are caused by lack of blood supply. Blood supply to nerve is reduced because of compression of blood vessels secondary to external pressure.
What Are The Symptoms Observed Following Minor Lateral Recess Narrowing?
Minor narrowing of the lateral recess causes irritation of sensory nerve. Irritation of sensory nerve causes symptoms like radicular pain and tingling. Tingling may result in numbness if cause of irritation is not removed or narrowing of lateral recess become significant.
What Is Radicular Pain?
Radicular pain is a chronic pain if pain continues after 6 months. Radicular pain may or may not be associated with tingling, numbness or weakness of muscles. Pain mostly travels along the pathway of the nerve. Radicular pain of neck is observed in arms and lumbar radicular pain spreads in lower legs.
What Are the Symptoms Following Major Lateral Recess Narrowing?
Symptoms observed following severe narrowing of lateral recess are radicular pain, tingling, numbness and weakness in muscles supplied by the nerve.
What Causes Lateral Recess Narrowing?
Lateral recess narrowing is caused by disc bulge, disc herniation, severe degenerative disc disease and osteophytes.1 The recess is a narrow tube, which has enough space for nerve to pass through to the surrounding organs and tissues. The recess become narrow when portion of the cylindrical space is occupied by herniated disc, bulge disc and osteophytes. Diameter of lateral recess depends on height of disc. Lateral recess becomes narrow when disc is degenerated or collapsed resulting in tightening of the space.
How Is Lateral Recess Narrowing Diagnosed?
Lateral recess narrowing is diagnosed following Magnetic Resonance Imaging (MRI)2 or Computer Tomography (CT) scan image studies. The image should show narrowing of the lateral recess.
What Is The Treatment To Relieve Symptoms Of Lateral Recess Narrowing?
Treatment is divided as conservative treatment, interventional therapy or surgery. Conservative treatment is medications, chiropractic therapy and physical therapy (PT). Interventional therapy is transforaminal epidural steroid injection or epidural steroid injection. Surgery is foraminectomy (widening recess), discectomy (removal of disc protruding in to recess),3 endoscopic decompression4 and spinal fusion.
1. Histomorphological analysis of the osteophytic appositions in patients with lumbar lateral recess syndrome.
Bajek G1, Bajek S, Cvek SZ, Bobinac D, Splavski B, Grahovac DS.
Coll Antropol. 2010 Apr;34 Suppl 2:79-84.
2. Factors affecting dynamic foraminal stenosis in the lumbar spine.
Singh V1, Montgomery SR, Aghdasi B, Inoue H, Wang JC, Daubs MD.
Spine J. 2013 Sep;13(9):1080-7.
3. Percutaneous endoscopic transforaminal approach to decompress the lateral recess in an elderly patient with spinal canal stenosis, herniated nucleus pulposus and pulmonary comorbidities.
Kitahama Y1, Sairyo K, Dezawa A.
Asian J Endosc Surg. 2013 May;6(2):130-3.
4. Extraforaminal compression of the L-5 nerve root at the lumbosacral junction: clinical analysis, decompression technique, and outcome.
Lee S1, Kang JH, Srikantha U, Jang IT, Oh SH.
J Neurosurg Spine. 2014 Jan 24.