Lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis

Figures & data

Table I. Patients' data.

Case	Gender, age (years)	Duration of RA (years)	Mutilating	Classification	Affected nerve root	Treatment
1	F, 74	17	+	Stage IV, Class 4	Left L4 → Right L4 ^a	Decompression
2	F, 69	28	+	Stage IV, Class 4	Right L4	Decompression
3	F, 57	25	+	Stage III, Class 3	Right L3	Decompression and fusion
4	F, 74	2	+	Stage IV, Class 3	Right L4	Conservative
5	F, 65	26	-	Stage IV, Class 3	Left L3	Decompression and fusion
6	F, 75	3	-	Stage II, Class 3	Bilateral L4	Decompression

^a Re-operated.

Figure 1. A 69-year-old women, with right L4 radiculopathy as revealed by postmyelographic CT scan. A: In the coronal section, bilateral L4 roots were well depicted. B: In the sagittal section, osteoporosis is evident; multiple vertebral collapse and end-plate irregularity are observed despite no history of trauma. C: In the sagittal section through the right foramen, foraminal stenosis is not obvious. D: In the transverse section (L3/4), spinal canal stenosis is very mild. E: In the transverse section (L4/5), prominent L4/5 facet joint destruction and lateral dislocation are noted.

Figure 2. Magnetic resonance imaging (MRI). A: In the sagittal section (right L4/5 foramen; T1-weighted image), foraminal stenosis is not obvious (arrow). B: In the transverse section (L4/5 foramen; T2-weighted image) as well, foraminal stenosis is not evident.

Figure 3. Selective radiculography (SRG) (right L4 nerve root). A: Posteroanterior view. B: Oblique view. The right L4 nerve root is compressed from underneath by the L5 superior articular process (arrow). Pain reproduction at the time of nerve puncture and nerve block induction were confirmed.