Reconsideration of lumbar spinal stenosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Yu ¹ ,  KONG Qingquan ^1,2 ,  CHEN Zhongqiang ³

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Orthopedics, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu Sichuan, 610041, P.R.China;
3. Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, P.R.China;

Corresponding author：

KONG Qingquan, Email: kqqspine@126.com; CHEN Zhongqiang, Email: puh3_czq@bjmu.edu.cn

Keywords：

Lumbar central canal stenosis; lumbar lateral spinal stenosis; percutaneous endoscopic lumbar discectomy

DOI：

10.7507/1002-1892.201904027

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People’s understanding of lumbar spinal stenosis has become more and more comprehensive and reasonable, however, there are still many controversies about the concepts of " central lumbar canal” and " lateral lumbar spinal canal”, and there is no unified standard at present. In this paper, we redefine and differentiate the two concepts. We believe that some kinds of central canal stenosis caused by bilateral recess stenosis can be completely solved by bilateral percutaneous endoscopic transforaminal discectomy. At the same time, the concept of " lumbar lateral recess” is ambiguous. We redefine it as " lateral lumbar spinal canal” and propose " West China Hospital classification” to guide surgical decision-making, which has been widely recognized and applied.

Citation： WANG Yu, KONG Qingquan, CHEN Zhongqiang. Reconsideration of lumbar spinal stenosis. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(7): 789-794. doi: 10.7507/1002-1892.201904027 Copy

1.	Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med, 2008, 358(8): 818-825.
2.	Verbiest H. A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg (Br), 1954, 36-B(2): 230-237.
3.	北美脊柱学会(NASS). 退变性椎管狭窄诊治指南. 2版. 2011. https://www.spine.org/Pages/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx.
4.	腰椎管狭窄症手术治疗规范中国专家共识组. 腰椎管狭窄症手术治疗规范中国专家共识 (2014年). 中华医学杂志, 2014, 94(35): 2724-2725.
5.	侯树勋, 吴闻文, 商卫林, 等. 腰椎管侧隐窝狭窄症的再认识. 中华骨科杂志, 1997, (12): 7-9.
6.	Schroeder GD, Kurd MF, Vaccaro AR. Lumbar spinal stenosis: how is it classified? J Am Acad Orthop Surg, 2016, 24(12): 843-852.
7.	Weber C, Rao V, Gulati S, et al. Inter- and intraobserver agreement of morphological grading for central lumbar spinal stenosis on magnetic resonance imaging. Global Spine J, 2015, 5(5): 406-410.
8.	Yuan S, Zou Y, Li Y, et al. A clinically relevant MRI grading system for lumbar central canal stenosis. Clin Imaging, 2016, 40(6): 1140-1145.
9.	Verbiest H. Stenosis of the lumbar vertebral canal and sciatica. Neurosurg Rev, 1980, 3(1): 75-89.
10.	Ullrich CG, Binet EF, Sanecki MG, et al. Quantitative assessment of the lumbar spinal canal by computed tomography. Radiology, 1980, 134(1): 137-143.
11.	Sirvanci M, Bhatia M, Ganiyusufoglu KA, et al. Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging. Eur Spine J, 2008, 17(5): 679-685.
12.	Azimi P, Mohammadi HR, Benzel EC, et al. Lumbar spinal canal stenosis classification criteria: a new tool. Asian Spine J, 2015, 9(3): 399-406.
13.	Laudato PA, Kulik G, Schizas C. Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis. Eur Spine J, 2015, 24(10): 2264-2268.
14.	McCulloch JA. 脊柱外科微创手术精要. 邹海波, 译. 北京: 世界图书出版公司, 2014: 231-232.
15.	Wang Y, Yan Y, Yang J, et al. Outcomes of percutaneous endoscopic trans-articular discectomy for huge central or paracentral lumbar disc herniation. Int Orthop, 2019, 43(4): 939-945.
16.	王玉, 孔清泉, 宋跃明. 精准椎间孔成形减压术治疗腰椎侧隐窝狭窄症的近期疗效分析. 中国修复重建外科杂志, 2017, 31(11): 1334-1340.
17.	Wang Y, Dou Q, Yang J, et al. Percutaneous endoscopic lumbar decompression for lumbar lateral spinal canal stenosis: classification of lateral region of lumbar spinal canal and surgical approaches. World Neurosurg, 2018, 119: e276-e283.
18.	Komp M, Hahn P, Merk H, et al. Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach: prospective 2-year results of 74 patients. J Spinal Disord Tech, 2011, 24(5): 281-287.
19.	Komp M, Hahn P, Oezdemir S, et al. Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician, 2015, 18(1): 61-70.
20.	Lee CW, Yoon KJ, Jun JH. Percutaneous endoscopic laminotomy with flavectomy by uniportal, unilateral approach for the lumbar canal or lateral recess stenosis. World Neurosurg, 2018, 113: e129-e137.
21.	Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
22.	Shin SH, Bae JS, Lee SH, et al. Transforaminal endoscopic decompression for lumbar spinal stenosis: a novel surgical technique and clinical outcomes. World Neurosurg, 2018, 114: e873-e882.
23.	Vital JM, Lavignolle B, Grenier N, et al. Anatomy of the lumbar radicular canal. Anat Clin, 1983, 5(3): 141-151.
24.	Lassale B, Morvan G, Gottin M. Anatomy and radiological anatomy of the lumbar radicular canals. Anat Clin, 1984, 6(3): 195-201.
25.	Crock HV. Normal and pathological anatomy of the lumbar spinal nerve root canals. J Bone Joint Surg (Br), 1981, 63B(4): 487-490.
26.	Epstein JA, Epstein BS, Rosenthal AD, et al. Sciatica caused by nerve root entrapment in the lateral recess: the superior facet syndrome. J Neurosurg, 1972, 36(5): 584-589.
27.	Ciric I, Mikhael MA, Tarkington JA, et al. The lateral recess syndrome. A variant of spinal stenosis. J Neurosurg, 1980, 53(4): 433-443.
28.	Lee CK, Rauschning W, Glenn W. Lateral lumbar spinal canal stenosis: classification, pathologic anatomy and surgical decompression. Spine (Phila Pa 1976), 1988, 13(3): 313-320.
29.	Schlesinger PT. Incarceration of the first sacral nerve in a lateral bony recess of the spinal canal as a cause of sciatica. J Bone Joint Surg (Am), 1955, 37-A(1): 115-124.
30.	Spivak JM. Degenerative lumbar spinal stenosis. J Bone Joint Surg (Am), 1998, 80(7): 1053-1066.
31.	Wang Y, Kong Q. To the editor. Spine (Phila Pa 1976), 2017, 42(20): E1212-E1213.

1. Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med, 2008, 358(8): 818-825.
2. Verbiest H. A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg (Br), 1954, 36-B(2): 230-237.
3. 北美脊柱学会(NASS). 退变性椎管狭窄诊治指南. 2版. 2011. https://www.spine.org/Pages/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx.
4. 腰椎管狭窄症手术治疗规范中国专家共识组. 腰椎管狭窄症手术治疗规范中国专家共识 (2014年). 中华医学杂志, 2014, 94(35): 2724-2725.
5. 侯树勋, 吴闻文, 商卫林, 等. 腰椎管侧隐窝狭窄症的再认识. 中华骨科杂志, 1997, (12): 7-9.
6. Schroeder GD, Kurd MF, Vaccaro AR. Lumbar spinal stenosis: how is it classified? J Am Acad Orthop Surg, 2016, 24(12): 843-852.
7. Weber C, Rao V, Gulati S, et al. Inter- and intraobserver agreement of morphological grading for central lumbar spinal stenosis on magnetic resonance imaging. Global Spine J, 2015, 5(5): 406-410.
8. Yuan S, Zou Y, Li Y, et al. A clinically relevant MRI grading system for lumbar central canal stenosis. Clin Imaging, 2016, 40(6): 1140-1145.
9. Verbiest H. Stenosis of the lumbar vertebral canal and sciatica. Neurosurg Rev, 1980, 3(1): 75-89.
10. Ullrich CG, Binet EF, Sanecki MG, et al. Quantitative assessment of the lumbar spinal canal by computed tomography. Radiology, 1980, 134(1): 137-143.
11. Sirvanci M, Bhatia M, Ganiyusufoglu KA, et al. Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging. Eur Spine J, 2008, 17(5): 679-685.
12. Azimi P, Mohammadi HR, Benzel EC, et al. Lumbar spinal canal stenosis classification criteria: a new tool. Asian Spine J, 2015, 9(3): 399-406.
13. Laudato PA, Kulik G, Schizas C. Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis. Eur Spine J, 2015, 24(10): 2264-2268.
14. McCulloch JA. 脊柱外科微创手术精要. 邹海波, 译. 北京: 世界图书出版公司, 2014: 231-232.
15. Wang Y, Yan Y, Yang J, et al. Outcomes of percutaneous endoscopic trans-articular discectomy for huge central or paracentral lumbar disc herniation. Int Orthop, 2019, 43(4): 939-945.
16. 王玉, 孔清泉, 宋跃明. 精准椎间孔成形减压术治疗腰椎侧隐窝狭窄症的近期疗效分析. 中国修复重建外科杂志, 2017, 31(11): 1334-1340.
17. Wang Y, Dou Q, Yang J, et al. Percutaneous endoscopic lumbar decompression for lumbar lateral spinal canal stenosis: classification of lateral region of lumbar spinal canal and surgical approaches. World Neurosurg, 2018, 119: e276-e283.
18. Komp M, Hahn P, Merk H, et al. Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach: prospective 2-year results of 74 patients. J Spinal Disord Tech, 2011, 24(5): 281-287.
19. Komp M, Hahn P, Oezdemir S, et al. Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician, 2015, 18(1): 61-70.
20. Lee CW, Yoon KJ, Jun JH. Percutaneous endoscopic laminotomy with flavectomy by uniportal, unilateral approach for the lumbar canal or lateral recess stenosis. World Neurosurg, 2018, 113: e129-e137.
21. Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
22. Shin SH, Bae JS, Lee SH, et al. Transforaminal endoscopic decompression for lumbar spinal stenosis: a novel surgical technique and clinical outcomes. World Neurosurg, 2018, 114: e873-e882.
23. Vital JM, Lavignolle B, Grenier N, et al. Anatomy of the lumbar radicular canal. Anat Clin, 1983, 5(3): 141-151.
24. Lassale B, Morvan G, Gottin M. Anatomy and radiological anatomy of the lumbar radicular canals. Anat Clin, 1984, 6(3): 195-201.
25. Crock HV. Normal and pathological anatomy of the lumbar spinal nerve root canals. J Bone Joint Surg (Br), 1981, 63B(4): 487-490.
26. Epstein JA, Epstein BS, Rosenthal AD, et al. Sciatica caused by nerve root entrapment in the lateral recess: the superior facet syndrome. J Neurosurg, 1972, 36(5): 584-589.
27. Ciric I, Mikhael MA, Tarkington JA, et al. The lateral recess syndrome. A variant of spinal stenosis. J Neurosurg, 1980, 53(4): 433-443.
28. Lee CK, Rauschning W, Glenn W. Lateral lumbar spinal canal stenosis: classification, pathologic anatomy and surgical decompression. Spine (Phila Pa 1976), 1988, 13(3): 313-320.
29. Schlesinger PT. Incarceration of the first sacral nerve in a lateral bony recess of the spinal canal as a cause of sciatica. J Bone Joint Surg (Am), 1955, 37-A(1): 115-124.
30. Spivak JM. Degenerative lumbar spinal stenosis. J Bone Joint Surg (Am), 1998, 80(7): 1053-1066.
31. Wang Y, Kong Q. To the editor. Spine (Phila Pa 1976), 2017, 42(20): E1212-E1213.

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