7. Lateral Recess Stenosis

Lumbar lateral recess stenosis is narrowing of the lateral, or subarticular, portion of the spinal canal through which a nerve root passes toward its intervertebral foramen. Unlike foraminal stenosis, it compresses the traversing rather than the exiting nerve root: for example, at L4–L5, the L5 nerve root, and at L5–S1, the S1 nerve root.

Narrowing may be caused by hypertrophy of the articular processes, particularly the superior articular process (SAP), degenerative disc bulging, and thickening of the ligamentum flavum. Compression of the traversing nerve root may present as radiculopathy; I correlate the images with the side and level of symptoms and the neurological examination.

In this chapter, I describe BESS/UBE decompression of the lateral recess. The aim is to release the traversing nerve root from compressive structures while preserving as much of the facet joint as possible. I determine the approach and extent of resection according to the anatomy and extent of stenosis.

Source of Figure 1: The Radiology Assistant—Lateral recess stenosis

References

1. Bui AT, Trinh GM, Wu MH, Hoang TT, Hu MH, Pao JL. Indications for and Outcomes of Three Unilateral Biportal Endoscopic Approaches for the Decompression of Degenerative Lumbar Spinal Stenosis: A Systematic Review. Diagnostics (Basel). 2023;13(6):1092. DOI: 10.3390/diagnostics13061092.

2. Park DK, Weng C, Zakko P, Choi DJ. Unilateral Biportal Endoscopy for Lumbar Spinal Stenosis and Lumbar Disc Herniation. JBJS Essent Surg Tech. 2023;13(2):e22.00020. DOI: 10.2106/JBJS.ST.22.00020.

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