The lateral recess is the space within the spinal canal that is located toward the sides and is close to the nerve roots. When this space is narrowed due to either genetic or acquired conditions, it is called as lateral recess stenosis.
Lateral recess stenosis is sometimes referred to as subarticular zone stenosis. It is a form of spinal stenosis where there is narrowing of the subarticular zone, including the lateral recess. This may be accompanied with or without other forms of spinal stenosis.
Because of this precarious location, lateral recess may be vulnerable to obstructions that impinge on emerging nerves.
Causes of Lateral Recess Stenosis
Lateral stenosis can occur due to age-related changes in bones, facet joints or ligaments. These changes can cause these structures to narrow the space we call the lateral recess and bump into the nearby spinal nerve root that normally pass through the lateral recess freely. This is called encroachment or impingement and may cause pronounced pain and other symptoms.
One possible cause of lateral recess stenosis is a herniated disc. The cushioning discs between your spinal bones can become damaged and bulged. The bulging disc can encroach on the foramen and nerve root.
On occasion, bone growths in and around your foramen can also pinch the nerves running through. Bone spurs form due to injury or degenerative conditions like osteoarthritis due to long term inflammation.
Sometimes, lateral recess spaces may be reduced in size due enlargement of ligaments around the spine and impinge on emerging nerves.
Lateral recess stenosis can also occur in people with cysts or tumours in the surrounding area, which may grow into lateral recess space.
Symptoms of Lateral Recess Stenosis
Lateral recess stenosis generally results in symptoms that are directly related to compression of the nerve roots at the level of the stenosis. Both pain and muscular weakness may result from bone deformity, bulging of the herniated disc, or misalignment of vertebrae. Sometimes even with significant narrowing, symptoms may not develop.
Symptoms of pinched nerves due to lateral recess stenosis can vary depending on which part of your spine is affected. The pain may worsen with certain activities, like bending, twisting, reaching, coughing, or sneezing.
If the stenosis occurs in the neck, a sharp burning pain may travel down shoulders and arms. This may make moving your neck difficult. Sometimes muscular weakness or tingling sensation may also be experienced in the affected arm or side of the neck.
When a stenosis occurs in upper portion of your back, you may feel pain and numbness in the front of your body. This is the least common area to be affected by lateral recess stenosis.
If the stenosis occurs in the lower back, you may experience pain, tingling, numbness, and weakness in the buttock, leg, and sometimes the foot. Sciatica is a term you may have heard for this type of pain.
Diagnosis of Lateral Recess Stenosis
Lateral recess stenosis is diagnosed based on details about the signs and symptoms, medical history, physical examination and diagnostic imaging scans.
Physical examination: Physical examination involves gauging the degree of motion, site of pain and evaluation of nerve and muscle using specific movements.
Diagnostic imaging: Imaging studies to detect lateral recess stenosis may include X-rays, MRIs, CT scans or CT scan with myelogram. Nerve conduction studies may also be ordered.
Treatment of Lateral Recess Stenosis
The treatment for lateral recess stenosis are primarily conservative nonsurgical measures such as pain killers or steroid medication. Stretches and strengthening physiotherapy, activity modification and rest may also be recommended.
Surgery is considered when the signs and symptoms are indicative of severe radiculopathy, myelopathy, or incapacitating pain. The surgical procedure would be dependent on particular patient needs and cause of stenosis.
Minimally invasive endoscopic procedures such as laminectomy, foraminotomy or discectomy may be necessary. These surgeries aim to remove obstructions, like bone spurs and herniated disc material from the lateral recesses and decompress pinched nerve bundles.
