Microdecompression for Extraforaminal L5-S1 Disc Herniation; The Significance of Concomitant Foraminal Disc Herniation for Postoperative Leg Pain

  • Lee, Dong-Yeob (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Lee, Sang-Ho (Department of Neurosurgery, Wooridul Spine Hospital)
  • 발행 : 2008.07.28

초록

Objective : To analyze the relationship of concomitant foraminallumbar disc herniation (FLDH) with postoperative leg pain after microdecompression for extraforaminallumbar disc herniation (EFLDH) at the L5-S1 level. Methods : Sixty-five patients who underwent microdecompression for symptomatic EFLDH at the L5-S1 level were enrolled, According to the severity of accompanying FLDH, EFLDH was classified into four categories (Class I : no FLDH; Class II : mild to moderate FLDH confined within a lateral foraminal zone; Class III : severe FLDH extending to a medial foraminal zone; Class IV : Class III with intracanalicular disc herniation). The incidence of postoperative leg pain, dysesthesia, analgesic medication, epidural block, and requirement for revision surgery due to leg pain were evaluated and compared at three months after initial surgery. Results : The incidences of postoperative leg pain and dysesthesia were 36.9% and 26.1%, respectively. Pain medication and epidural block was performed on 40% and 41.5%, respectively, Revision surgery was recommended in six patients (9.2%) due to persistent leg pain, The incidences of leg pain, dysesthesia, and requirement for epidural block were higher in Class III/IV, compared with Class I/II. The incidence of requirement for analgesic medication was significantly higher in Class III/IV, compared with Class I/II (p=0,02, odds ratio=9,82). All patients who required revision surgery due to persistent leg pain were included in Class III/IV. Conclusion : Concomitant FLDH seems related to postoperative residual leg pain after microdecompression for EFLDH at the L5-S1 level.

키워드

참고문헌

  1. Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB : Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res 157 : 191-199, 1981
  2. Chang SB, Lee SH, Ahn Y, Kim JM : Risk factor for unsatisfactory outcome after lumbar foraminal and far lateral microdecompression. Spine 31 : 1163-1167, 2006 https://doi.org/10.1097/01.brs.0000216431.69359.91
  3. Epstein NE : Foraminal and far lateral lumbar disc herniations : surgical alternatives and outcome measures. Spinal Cord 40 : 491-500, 2002 https://doi.org/10.1038/sj.sc.3101319
  4. Hasegawa T, Mikawa Y, Watanabe R, An HS : Morphometric analysis of the lumbosacral nerve roots and dorsal root ganglia by magnetic resonance imaging. Spine 21 : 1005-1009, 1996 https://doi.org/10.1097/00007632-199605010-00001
  5. Hashimoto M, Watanabe O, Hirano H : Extraforaminal stenosis in the lumbosacral spine. Efficacy of MR imaging in the coronal plane. Acta Radiol 37 : 610-613, 1996 https://doi.org/10.3109/02841859609177684
  6. Ivanov AA, Faizan A, Ebraheim NA, Yeasting R, Goel VK : The effect of removing the lateral part of the pars interarticularis on stress distribution at the neural arch in lumbar foraminal microdecompression at L3-L4 and L4-L5. Anatomic and finite element investigations. Spine 32 : 2462-2466, 2007 https://doi.org/10.1097/BRS.0b013e3181573d33
  7. Jang JS, An SH, Lee SH : Clinical analysis of extraforaminal entrapment of L5 in the lumbosacral spine. J Korean Neurosurg Soc 36 : 383-387, 2004
  8. Kotil K, Akcetin M, Bilge T : A minimally invasive transmuscular approach to far-lateral L5-S1 level disc herniations : a prospective study. J Spinal Disord Tech 20 : 132-138, 2007 https://doi.org/10.1097/01.bsd.0000211268.43744.2a
  9. Kunogi J, Hause M : Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine 16 : 1312-1320, 1991 https://doi.org/10.1097/00007632-199111000-00012
  10. Kurobane Y, Takahashi T, Tajima T, Yamakawa H, Sakamoto T, Sawaumi A, et al : Extraforaminal disc herniation. Spine 11 : 260-268, 1986 https://doi.org/10.1097/00007632-198604000-00014
  11. Lee DY, Lee SH, Lee HS : Unilateral isthmus resection for elderly foraminal stenosis. J Korean Neurosurg Soc 41 : 207-209, 2007 https://doi.org/10.3340/jkns.2007.41.3.207
  12. O'Toole JE, Eichholz KM, Fessler RG : Minimally invasive far lateral microendoscopic discectomy for extraforaminal disc herniation at the lumbosacral junction : cadaveric dissection and technical case report. Spine J 7 : 414-421, 2007 https://doi.org/10.1016/j.spinee.2006.07.008
  13. Ozveren MF, Bilge T, Barut S, Eras M : Combined approach for far-lateral lumbar disc herniation. Neurol Med Chir (Tokyo) 44 : 118-122 ; discussion 123, 2004 https://doi.org/10.2176/nmc.44.118
  14. Patrick BS : Extreme lateral ruptures of lumbar intervertebral discs. Surg Neurol 3 : 301-304, 1975
  15. Porchet F, Chollet-Bornand A, Tribolet N : Long-term follow up of patients surgically treated by the far-lateral approach for foraminal and extraforaminal lumbar disc herniations. J Neurosurg 90 : 59-66, 1999 https://doi.org/10.3171/jns.1999.90.1.0059
  16. Reulen HJ, Muller A, Ebeling U : Microsurgical anatomy of the lateral approach to extraforaminal lumbar disc herniations. Neurosurgery 39 : 345-350, 1996 https://doi.org/10.1097/00006123-199608000-00022
  17. Reulen HJ, Pfaundler S, Ebeling U : The lateral microsurgical approach to the "extracanalicular"lumbar disc herniation. I : A technical note. Acta Neurochir (Wien) 84 : 64-67, 1987 https://doi.org/10.1007/BF01456353
  18. Segnarbieux F, Van de Kelft E, Candon E, Bitoun J, Ferebeau P : Disco-computed tomography in extraforaminal and foraminal lumbar disc herniation : influence on surgical approaches. Neurosurgery 34 : 643-647, 1994 https://doi.org/10.1227/00006123-199404000-00011
  19. Tessitore E, de Tribolet N : Far-lateral lumbar disc herniation : the microsurgical transmuscular approach. Neurosurgery 54 : 939-942, 2004 https://doi.org/10.1227/01.NEU.0000115154.62636.77
  20. Viswanathan R, Swamy NK, Tobler W, Greiner AL, Keller JT, Dunsker SB : Extraforaminal lumbar disc herniations : microsurgical anatomy and surgical approach. J Neurosurg 96 : 206-211, 2002
  21. Wiltse LL, Spencer CW : New uses and refinements of the paraspinal approach to the lumbar spine. Spine 13 : 696-706, 1988 https://doi.org/10.1097/00007632-198813060-00019