Extreme Lateral Lumbar Disc Herniation : Pitfalls in Diagnosis and Operative Treatment

Study Design: Retrospective cohort study. Objective: The goal of this study was to determine whether the absolute size (mm2), relative size (% canal compromise), or location of a single-level, lumbar disc herniation (LDH) on axial and sagittal cuts of magnetic resonance imaging (MRI) were predictive of eventual surgical intervention. Methods: MRIs of 89 patients were reviewed, and patients were split into groups based on type of management received (34 nonoperative vs 55 microdiscectomy). Radiographic characteristics—including size of disc herniation (mm2), size of spinal canal (mm2), location of herniation on axial (central, paracentral, foraminal) and sagittal (disc level, suprapedicle, pedicle, infrapedicle) planes, and type of herniation (bulge, protrusion, extrusion, sequestration)—were measured by 2 independent, orthopedic spine fellows and compared between groups via univariate and multivariate analyses. Results: The operative group showed a significantly higher percentage of canal compromise (39.5% vs 31.1%, P = .001) compared to the nonoperative group. Multiple logistic regression analysis showed higher odds of eventual operative intervention for a disc protrusion (odds ratio [OR] 6.30 [1.99, 19.86], P = .002) or disc extrusion (OR 11.5 [1.63, 81.2], P = .014) for Rater 1 and a higher odds of eventual surgical management for a paracentral location for both Rater 1 and Rater 2 (OR = 3.39 [1.25, 9.22], P = .017, and OR = 5.46 [1.77, 16.8], P = .003, respectively). Conclusions: Disc herniations in a paracentral location were more likely to undergo operative treatment than those more centrally located, on axial MRI views.

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Meta-analysis of the operative treatment of lumbar disc herniation via transforaminal percutaneous endoscopic discectomy versus interlaminar percutaneous endoscopic discectomy in randomized trials

Medicine ◽

10.1097/md.0000000000023193 ◽

2021 ◽

Vol 100 (5) ◽

pp. e23193

Author(s):

Ding-Wen He ◽

Yan-Jie Xu ◽

Wei-Cai Chen ◽

Xin-Xin Miao ◽

Hui Wu ◽

...

Keyword(s):

Operative Treatment ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Randomized Trials ◽

Lumbar Disc ◽

Meta Analysis ◽

Endoscopic Discectomy

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Recurrent Lumbar Disc Herniation: A Narrative Review

10.13107/bbj.2020.v01i01.010 ◽

2020 ◽

Vol 1 (1) ◽

Keyword(s):

Risk Factors ◽

Operative Treatment ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Narrative Review ◽

Leg Pain ◽

Epidural Fibrosis ◽

Fusion Procedure ◽

Recurrent Lumbar Disc Herniation

This narrative review aimed to identify various risk factors of recurrent lumbar disc herniation (rLDH) post-discectomy and its management. The rLDH has remained a challenging problem for spine surgeons. The incidence of rLDH is reported widely from 1% to 21%. Many possible patient-related, disc-related, and surgery-related risk factors may predispose the patient to rLDH. Moreover, the clinical and radiological diagnosis of rLDH can be challenging. Once the diagnosis is confirmed, and alternative diagnoses for leg pain have been ruled out, a course of initial non-operative treatment can be attempted. Compared to primary LDH, non-operative treatment is less likely to succeed in rLDH, possibly due to the associated epidural fibrosis and scarring. Various surgical options can be considered, including revision discectomy and fusion. Revision discectomy is usually the primary choice of surgery for the first recurrence. A fusion procedure can be chosen for those who have repeated reherniations or significant associated back pain. Precise patient selection is a must to achieve excellent surgical outcomes. Keywords: Lumbar disc herniation, recurrent herniation, discectomy, risk factor, Epidural fibrosis, narrative review.

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Operative Treatment of Lumbar Disc Herniation

Journal of Korean Society of Spine Surgery ◽

10.4184/jkss.2001.8.3.327 ◽

2001 ◽

Vol 8 (3) ◽

pp. 327 ◽

Cited By ~ 1

Author(s):

Chong-Suh Lee

Keyword(s):

Operative Treatment ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc

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Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215517719952 ◽

2017 ◽

Vol 32 (2) ◽

pp. 146-160 ◽

Cited By ~ 15

Author(s):

Bing-Lin Chen ◽

Jia-Bao Guo ◽

Hong-Wei Zhang ◽

Ya-Jun Zhang ◽

Yi Zhu ◽

...

Keyword(s):

Confidence Interval ◽

Operative Treatment ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Mean Difference ◽

Short Term ◽

Significant Difference ◽

Physical Functions

Objective: To investigate the effects of surgical versus non-operative treatment on the physical function and safety of patients with lumbar disc herniation. Data sources: PubMed, Cochrane Library, Embase, EBSCO, Web of Science, China National Knowledge Infrastructure and Chinese Biomedical Literature Database were searched from initiation to 15 May 2017. Methods: Randomized controlled trials that evaluated surgical versus non-operative treatment for patients with lumbar disc herniation were selected. The primary outcomes were pain and side-effects. Secondary outcomes were function and health-related quality of life. A random effects model was used to calculate the pooled mean difference with 95% confidence interval. Results: A total of 19 articles that involved 2272 participants met the inclusion criteria. Compared with non-operative treatment, surgical treatment was more effective in lowering pain (short term: mean difference = −0.94, 95% confidence interval = −1.87 to −0.00; midterm: mean difference = −1.59, 95% confidence interval = −2.24 to −9.94), improving function (midterm: mean difference = −7.84, 95% confidence interval = −14.00 to −1.68; long term: mean difference = −12.21, 95% confidence interval = −23.90 to −0.52) and quality of life. The 36-item Short-Form Health Survey for physical functions (short term: mean difference = 6.25, 95% confidence interval = 0.43 to 12.08) and bodily pain (short term: mean difference = 5.42, 95% confidence interval = 0.40 to 10.45) was also utilized. No significant difference was observed in adverse events (mean difference = 0.82, 95% confidence interval = 0.28 to 2.38). Conclusion: Low-quality evidence suggested that surgical treatment is more effective than non-operative treatment in improving physical functions; no significant difference was observed in adverse events. No firm recommendation can be made due to instability of the summarized data.

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