Is that lumbar disc symptomatic? Herniated lumbar disc associated with contralateral radiculopathy

Abstract

Herniated lumbar disc may be asymptomatic or associated with lower limb radiculopathy. Most spinal surgeons would offer surgery following a period of conservative measures if the radiological and clinical findings correlate. However, the existing dictum that lumbar radiculopathy should correlate with ipsilateral lumbar disc herniation may not be accurate as it can rarely present with contralateral sciatica. Literature regarding this phenomenon is scarce. Therefore, we report a patient with herniated lumbar disc presenting with predominantly contralateral motor weakness radiculopathy, which resolved after discectomy.

Cervical disc herniation presenting with contralateral radiculopathy: A case report

“…Since our case presented as cervical radiculopathy, Yeung's hypothesis could not explain our patient's symptoms. Lumbar disc herniation causing contralateral radiculopathy has been reported by several studies [ [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ]. Several pathophysiological theories are proposed to explain the reasons for contralateral radiculopathy in patients with lumbar disc herniation [ 9 ].…”

“…Several pathophysiological theories are proposed to explain the reasons for contralateral radiculopathy in patients with lumbar disc herniation [ 9 ]. These theories include: postural changes bending to the opposite side of the herniated disc [ 10 ]; Kernohan notch-like phenomenon stretching the contralateral nerve root [ 11 ]; prominent epidural fat [ 12 ]; direct lateral shift and compression of the traversing fibers of the contralateral nerve roots against the contralateral pedicle and facet joint in the lateral recess [ 13 ]; epidural venous plexus engorgement and congestion [ 14 ]; inflammation [ 15 ]; traction forces [ 16 ]; dural attachments to the posterior longitudinal ligament [ 17 , 18 ]; and pre-existent spinal stenosis in the setting of lumbar spondylosis and yellow ligament hypertrophy [ 19 , 20 ]. They may bring some explanation for our patient's symptoms.…”