Surgery for patients with central protruded lumbar discs who have failed conservative therapy

Abstract

The clinical presentation and results of surgery of patients with central protruded lumbar discs have not been well defined or distinguished from studies of patients with lateral herniated discs. Many patients are denied surgical treatment, even though they are incapacitated by pain, because they do not have the classic radiographic findings seen in patients with lateral disc herniation. Sixty-three symptomatic patients with radiographically documented central lumbar disc protrusion were analysed. All patients had failed at least 6 months of conservative therapy. Although lumbar spinal pain was the most common complaint, 24 patients also presented with bilateral leg pain and 33 with unilateral leg pain; 26 had unilateral limitation of straight leg raising. An interesting observation was that unilateral symptoms and dural tension signs can be seen in patients with central disc protrusion. After surgical follow-up for a mean of 51 months, 86% achieved good results when analysed by the Prolo Functional Economic Outcome Rating Scale. It is postulated that pain is mediated by neuropeptides and arachidonic acid degradation products which are a response to mechanical annular injury.

SPORT Lumbar Intervertebral Disk Herniation and Back Pain

“…Beatty reported satisfactory clinical results in patients with central disc herniations treated with diskectomy, 15 whereas others found patients with an intact anulus benefited less from surgery than those with a ruptured anulus. 10,16 However, some suggest that outcomes are unrelated to herniation appearance on magnetic resonance imaging (MRI).…”

“…These results are not directly comparable with Beatty's cohort of patients with central disc herniations treated surgically. 15 A requisite of our study was the presence of sciatica, whereas Beatty did not use sciatica as an inclusion criterion and deliberately excluded patients with MRI evidence of nerve root impingement. Nonetheless, both studies did report good outcomes for central disc herniation patients overall.…”