title: Anterior decompression of foraminal stenosis below a lumbosacral transitional vertebra. A case report.
abstract: METHODS
  A case of unilateral far-out foraminal entrapment of the L5 spinal nerve below a transitional vertebra is presented with a review of the literature.
  
  
  OBJECTIVE
  To describe management of a rare far-out foraminal stenosis below a transitional vertebra and to evaluate the surgical procedure and results.
  
  
  BACKGROUND
  Far-out foraminal stenosis with radiculopathy caused by bony spur formation secondary to anomalous articulation between the transverse process and the sacral ala is rarely reported. Decompression at this point traditionally has been performed through a posterior approach, similar to that performed for the far-out syndrome. There are no previous reports describing anterior decompression through an extraperitoneal approach.
  
  
  METHODS
  The diagnosis was confirmed by computed tomography, magnetic resonance imaging, and selective radiculography. Anterior decompression was performed by resecting the bony spur using a wide muscle-splitting extraperitoneal approach.
  
  
  RESULTS
  Anterior decompression was performed with minimal intervention to the spine and the trunk muscles. Good relief of low back pain and sciatica was obtained.
  
  
  CONCLUSIONS
  Selective radiculography was the method of examination with the optimal diagnostic value for far-out foraminal stenosis. An anterior approach to the decompression of far-out foraminal stenosis below a lumbosacral transitional vertebra is a relatively simple and effective method.
authors.affiliation: Department of Orthopaedic Surgery, Akita University School of Medicine, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Abe
authors.forename: K
authors.initials: K
authors.lastname: Sato
authors.forename: Y
authors.initials: Y
authors.lastname: Shimada
authors.forename: K
authors.initials: K
authors.lastname: Okada
authors.forename: K
authors.initials: K
authors.lastname: Yan
authors.forename: Y
authors.initials: Y
authors.lastname: Mizutani
mesh_terms: D000328:Adult; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009408:Nerve Compression Syndromes / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013127:Spinal Nerves / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed