CT recognition of lateral lumbar disk herniation

Williams, A L; Haughton, V M; Daniels, David L.; Thornton, Robert S.

doi:10.2214/ajr.139.2.345

Cited by 35 publications

(13 citation statements)

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“…As discussed above, noncontained fragments in the majority were caudally displaced (Table 3) mostly in the medio-lateral or lateral position, thus affecting the nerve root of these or the next lower level. High resolution CT with adequate reformations 5, 13,14,16,24,37,38 or MRI a' 4, 9, 21, 25, today allows in most patients an exact localisation of the herniations as well as information about the donor disc, the relation to the dural sac, often also the PLL and the lateral recess. Based on good pre-operative imaging and knowledge of the surgical anatomy the surgical procedure can be adjusted much more reliably to the individual pathology than in the past.…”

Section: Anatomical Considerations and Clinical Implicationsmentioning

confidence: 99%

Are there typical localisations of lumbar disc herniations? A prospective study

1992

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A prospective intra-operative analysis of the location of lumbar disc herniation was performed in 131 patients with verified 54% contained (incomplete) and 46% non-contained (complete) lumbar disc herniations. Bulging discs or protrusions are not included in this study. Complete disc herniations occurred more frequently in the upper lumbar spine. The localization of the lumbar disc herniations within its segment showed no correlation to the affected level. 64% of the disc herniations were located medio-laterally, 20% laterally, 12% within or lateral of the intervertebral compartment and 5% in the midline. Nearly one third of all herniations were found at the level of the disc space. Medio-lateral disc herniations were displaced more often in a caudal direction, lateral herniations were found displaced upwards and downwards with similar frequency while extraforminal herniations migrated significantly more often in a cranial direction. The pathomechanism and anatomical pathways of disc fragment migration are discussed on the basis of a new concept of the anterior extradural space.

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Section: Anatomical Considerations and Clinical Implicationsmentioning

confidence: 99%

Are there typical localisations of lumbar disc herniations? A prospective study

1992

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“…1-5 LLDH were first described by Abdullah and co-workers in 1974 and the clinical features have often been discussed since then. [6][7][8][9][10][11][12][13][14] During the last decade several surgical approaches to this type of herniation have been described. Some advocate the interlaminar medial approach with partial or complete facetectomy.…”

mentioning

confidence: 99%

Lateral transmuscular or combined interlaminar/paraisthmic approach to lateral lumbar disc herniation? A comparative clinical series of 48 patients

Ryang

Rohde²,

İnce³

et al. 2005

Journal of Neurology, Neurosurgery & Psychiatry

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Background: The optimum operative technique for lateral lumbar disc herniations (LLDH) remains unclear, and both interlaminar and extraspinal approaches are used. Objective: To compare outcome after LLDH removal either by a lateral transmuscular approach (LTM) or by a combined interlaminar and paraisthmic approach (CIP). Methods: 28 patients underwent surgery using CIP and 20 using LTM. All patients were operated on by the same neurosurgeon. The clinical presentation of the two groups was comparable. Overall outcome was assessed after a mean follow up period of between 19 and 37 months using the Ebeling classification. In addition, the effect of surgery on radicular pain, low back pain, and sensory and motor deficits was defined.Results: Excellent to good results were achieved in 95% of the LTM group and 57% of the CIP group. The outcome was satisfactory to poor in 5% of the LTM and 43% of the CIP group (p,0.004). The percentage of sensorimotor deficit and of radicular pain improvement was higher in the LTM group. New low back pain was found exclusively in the CIP group (21%). The complication rate was 5% in the LTM group and 11% in the CIP group. Conclusions: The LTM approach achieves a better overall outcome and improvement in radiculopathy. The complication rate is lower with the transmuscular route and the risk of new low back pain is minimised. These results are likely to be attributable at least in part to the lesser invasiveness of the LTM approach.

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“…High-resolution CT scan studies of lateral, foraminal, or extraforaminal herniation is dependent on the differential densities of the disc material, nerve root, epidural fat, and the thecal sac. 29 In this series, standard CT scan slices were used in all the patients to facilitate the diagnosis of the foraminal and extraforaminal disc herniations. Standard CT scan views can clearly demonstrate foraminal and extraforaminal disc herniations, by comparing them with views taken from the contralateral side.…”

Section: Discussionmentioning

confidence: 99%

“…Standard CT scan views can clearly demonstrate foraminal and extraforaminal disc herniations, by comparing them with views taken from the contralateral side. 29,30 In this series, MRI with a standard axial and parasagittal view was the diagnosis tool of choice for visualizing the foraminal and extraforaminal disc herniations. As with foraminal disc herniations, upward No improvement or no sufficient improvement to enable increase in activities; further operative intervention required migrated disc material is detected on the parasagittal view through the lateral exit zone.…”

Section: Discussionmentioning

confidence: 99%

Transforaminal Percutaneous Endoscopic Discectomy in the Treatment of Foraminal and Extraforaminal Lumbar Disc Herniations

Jang

An²,

Lee³

2006

Journal of Spinal Disorders &Amp; Techniques

128

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The objective of this study is to evaluate the efficacy of the endoscopic technique, as applied to patients with foraminal and extraforaminal disc herniations, and to report the outcome and complications. A retrospective analysis was performed of 35 consecutive cases of foraminal and extraforaminal lumbar disc herniation managed by posterolateral endoscopic discectomy. Pain was measured by means of the Visual Analog Score. Patient satisfaction was evaluated by the Macnab outcome criteria. The median follow-up period was 18 months (range 10 to 35 months). The mean Visual Analog Score improved from 8.6 before the surgery to 3.2 after the surgery. Overall, excellent or good outcomes were obtained in 30 (85.7%) of the 35 patients at the last follow-up examination, with both these outcomes showing statistically significant improvement (P<0.01). There were no complications related to the surgery, nor was any spinal instability detected. Three patients (8.6%) experienced persistent radiculopathy and subsequently underwent open microdiscectomy at the same level. We concluded that transforaminal percutaneous endoscopic discectomy is safe and efficacious in the treatment of foraminal or extraforaminal disc herniations. However, proper patient selection is paramount to ensure a satisfactory outcome after decompression of foraminal and extraforaminal disc herniations.

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CT recognition of lateral lumbar disk herniation

Cited by 35 publications

References 0 publications

Are there typical localisations of lumbar disc herniations? A prospective study

Are there typical localisations of lumbar disc herniations? A prospective study

Lateral transmuscular or combined interlaminar/paraisthmic approach to lateral lumbar disc herniation? A comparative clinical series of 48 patients

Transforaminal Percutaneous Endoscopic Discectomy in the Treatment of Foraminal and Extraforaminal Lumbar Disc Herniations

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