Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures

被引:142
作者
Epstein, NE
机构
[1] Albert Einstein Coll Med, Bronx, NY 10467 USA
[2] N Shore Long Isl Jewish Hlth Syst, Dept Neurosurg, Manhasset, NY 11030 USA
[3] Long Isl Neurosurg Assoc, New Hyde Pk, NY 11040 USA
关键词
lumbar foraminal discs; far lateral discs;
D O I
10.1038/sj.sc.3101319
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Far lateral disc herniations constitute 7 - 12% of all disc herniations. They may be purely far lateral or extraforaminal in location, located beyond the pedicles, or may include intraforaminal and even intracanalicular components. Occurring predominantly at the L4-L5 and L3-L4 levels in almost equal numbers, they are occasionally noted at L5-S1. Clinical syndromes reflect compression of the superiorly exiting nerve root and ganglion; ie an L4-L5 far lateral disc produces a L4 root syndrome. Clinical complaints often include severe radicular pain accompanied by very positive mechanical signs; Lasegue and reverse Lasegue (femoral stretch test) maneuvers. Neurological deficits, including motor, reflex, and sensory findings, are seen over 75% of the time. Although conservative management is occasionally successful (10%), surgery is usually required. The extent of stenosis and attendant degenerative changes dictate whether laminectomy, hemilaminectomy or laminotomy are required along with one of several facet resection options; full facetectomy, the intertransverse approach, medial facetectomy, or an extreme lateral procedure. Postoperatively, patients' neurological outcomes based on both surgeon and patient based outcome measures (SF-36), were comparable for the different surgical procedures which had been based on the individual patient's pathology.
引用
收藏
页码:491 / 500
页数:10
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