Sciatica caused by nerve root entrapment in the lateral recess: the superior facet syndrome

✓ Fifteen patients with intense sciatic pain in whom surgical exploration disclosed no evidence of a herniated disc were found to have an entrapped L-5 or S-1 nerve root in a stenotic lateral recess beneath the superior articular facet of the inferior vertebra. Neurological abnormalities were infrequent. A conspicuously positive Lasègue sign was the most definite and consistent finding. Roentgenograms of the spine were not helpful, and myelography was negative or showed minimal changes because of the normal ventrodorsal diameter of the spinal canal and the lack of filling of the narrow lateral recesses. Electromyography was positive in the five patients studied. Surgical unroofing of the lateral recess with removal of the overhanging horizontal portion of the superior facet decompressed the incarcerated nerve root and relieved symptoms.