The diagnosis and surgical options for extreme lateral lumbar disc herniation

LIAO Wei; QIU Bo; XIE Ming

doi:10.3969/j.issn.1674-666X.2015.04.001

Abstract：Objective To investigate the diagnosis and individualized surgery options for extreme lateral lumber disc herniation (ELLDH).Methods From February 2004 to February 2012,26 consecutive patients with ELLDH were treated surgically in People's Hospital of Wuhan University,and their clinical data were retrospectively analyzed in this study.Fenestration laminectomy and discectomy was performed in 7 cases,posterior lumbar interbody fusion (PLIF) with partial laminectomy and pedicle screw fixation was done in 8 patients while transforaminal lumbar interbody fusion (TLIF) with trans-isthmus facet joint excision,discetomy and pedicle screw fixation was performed in 11 patients.Accuracy rate of diagnosis was compared among 3 radiological methods of CT scanning,MRI,MRI combined with CT scanning; Japanese Orthopaedic Association (JOA) scores were evaluated before the surgery and at the last follow-up,grafting bony fusion and complications were also observed.Results Accuracy rate of diagnosis was respectively as 92% (24/26) in CT scanning,88%(23/26) in MRI,and 100% (26/26) in MRI combined with CT scanning,the differences among 3 methods had no statistical significance (χ2 = 2.992,P= 0.224).Pain symptoms in all patients had been relieved fully.The average follow-up was 3.5 years (2 to 6 years).No disc re-herniation were found and none of them needed revision surgery.The differences of JOA score between preoperation and the last follow-up had statistical significance [(11.5 ± 2.8) vs (25.8 ± 4.2); t = 14.445,P = 0.000],and the mean JOA improvement rate was 85%.Of 7 patients who underwent fenestration laminectomy and discectomy,there was one patient suffered from low back pain and instability in lumbar spine 5 years later,while others showed good effects;And those patients with PLIF or TLIF obtained solid bony fusion without pseudarthrosis.No loosening or breakage of the pedicle screws were found and no Cage subsidence or dislocation had happened.Conclusions ELLDH is characterized by complicated clinical symptoms and is relatively difficult to diagnosis,MRI combined with CT scanning is helpful for the diagnosis of ELLDH; ELLDH patients could obtain long-term effects with satisfied pain relief,good bony fusion and less complications by the individualized surgery.