Lumbar foraminal stenosis, the hidden stenosis including at L5/S1

  • Sumihisa Orita
  • Kazuhide Inage
  • Yawara Eguchi
  • Go Kubota
  • Yasuchika Aoki
  • Junichi Nakamura
  • Yusuke Matsuura
  • Takeo Furuya
  • Masao Koda
  • Seiji Ohtori
Expert's Opinion • SPINE - LUMBAR


In patients with lower back and leg pain, lumbar foraminal stenosis (LFS) is one of the most important pathologies, especially for predominant radicular symptoms. LFS pathology can develop as a result of progressing spinal degeneration and is characterized by exacerbation with foraminal narrowing caused by lumbar extension (Kemp’s sign). However, there is a lack of critical clinical findings for LFS pathology. Therefore, patients with robust and persistent leg pain, which is exacerbated by lumbar extension, should be suspected of LFS. Radiological diagnosis is performed using multiple radiological modalities, such as magnetic resonance imaging, including plain examination and novel protocols such as diffusion tensor imaging, as well as dynamic X-ray, and computed tomography. Electrophysiological testing can also aid diagnosis. Treatment options include both conservative and surgical approaches. Conservative treatment includes medication, rehabilitation, and spinal nerve block. Surgery should be considered when the pathology is refractory to conservative treatment and requires direct decompression of the exiting nerve root, including the dorsal root ganglia. In cases with decreased intervertebral height and/or instability, fusion surgery should also be considered. Recent advancements in minimally invasive lumbar lateral interbody fusion procedures enable effective and less invasive foraminal enlargement compared with traditional fusion surgeries such as transforaminal lumbar interbody fusion. The lumbosacral junction can cause L5 radiculopathy with greater incidence than other lumbar levels as a result of anatomical and epidemiological factors, which should be better addressed when treating clinical lower back pain.


Foramen Lumbar spine Radiculopathy Fusion Diffusion tensor imaging (DTI) Oblique lateral interbody fusion (OLIF) 


Compliance with ethical standards

Conflict of interest

All of the authors do not have any conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Graduate School of MedicineChiba UniversityChibaJapan
  2. 2.Department of Orthopaedic Surgery, National Hospital OrganizationShimoshizu HospitalYotsukaidoJapan
  3. 3.Department of Orthopaedic SurgeryEastern Chiba Medical CenterToganeJapan

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