title: Anterior decompression for far-out syndrome below a transitional vertebra: a report of two cases.
abstract: BACKGROUND
  Impingement of the L5 nerve between the transverse process of L5 and the ala of sacrum has been described as the far-out syndrome. Posterior decompression is often performed for this pathology.
  
  
  OBJECTIVE
  To describe rare cases of far-out syndrome below a transitional vertebra who underwent anterior decompression.
  
  
  METHODS
  A case report and a review of the literature.
  
  
  METHODS
  Review of the hospital medical record, history, physical examination, and imaging studies.
  
  
  RESULTS
  A 70-year-old woman and a 53-year-old man presented with prolonged and progressive leg pain and/or low back pain. Both of the patients showed muscle weakness and sensory disturbance at L5 level and lumbosacral transitional vertebra on the plain radiography. Magnetic resonance imaging showed huge osteophytes, and there was severe impingement of the L5 nerve at the anterior exit zone of the foramen. Anterior decompression was performed for both cases using a Fraser incision and resulted in successful resolution of the symptom and neurological status.
  
  
  CONCLUSIONS
  In the extraforaminal stenosis of the L5 nerve with far-out syndrome below the transitional vertebra, entrapment occurs more anterior of exit zone of the L5 nerve foramen than in the other pathologies; anterior decompression brings in more complete decompression.
authors.affiliation: Department of Orthopedic Surgery, Akita Kumiai General Hospital, 1-1-1 Nishibukuro Iijima, Akita 011-0948, Japan. kk8500@nifty.com
authors.forename: Kazuma
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Eiji
authors.initials: E
authors.lastname: Abe
authors.forename: Naohisa
authors.initials: N
authors.lastname: Miyakoshi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Toshiki
authors.initials: T
authors.lastname: Abe
authors.forename: Michio
authors.initials: M
authors.lastname: Hongo
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Shimada
mesh_terms: D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D016896:Treatment Outcome
keywords: Anterior decompression; Far-out syndrome; Lumbar spine; Transitional vertebra