Lumbar disk herniation with contralateral symptoms

Abstract

IntroductionDuring the workup of a patient with leg pain, finding a contralateral disk herniation without any significant abnormality on the ipsilateral side on imaging studies is a dilemma for a doctor. He is faced with the problem of deciding whether or not the presenting symptoms are related to the herniated disk. In such a situation, the spinal surgeon fears to offer operation due to the risk of failed back surgery syndrome and he either withholds surgery or chooses to explore both sides of the spinal canal not to miss a lesion that might be responsible for the symptoms. However, exploring the side without lesions on imaging studies in addition to diskectomy not only increases the operation time, but also doubles complication risks. Several authors have reported on patients with lumbar herniated disks and contralateral symptoms who recovered after operation, but all of them had operated the patients from both sides of the canal [2,4,5]. Therefore, in these cases, it is not possible to make sure that relief of symptoms were related only to removal of herniated disks; decompression at the symptomatic side might have also influenced the recovery.We present a series of five patients with lumbar herniated disks and contralateral symptoms. In all patients, herniated disks were removed without intervention to the contralateral side. To our knowledge, this is the first reported series of such patients who were operated only from the herniation side. The possible mechanisms of how contralateral symptoms predominate in these patients are also discussed. Hasan Kamil Sucu Fazıl GelalLumbar disk herniation with contralateral symptoms Abstract The aim of the study is to determine if leg pain can be caused by contralateral lumbar disk herniation and if intervention from only the herniation side would suffice in these patients. Five patients who had lumbar disk herniations with predominantly contralateral symptoms were operated from the side of disk herniation without exploring or decompressing the symptomatic side. Patients were evaluated preand postoperatively. To our knowledge, this is the first reported series of such patients who were operated only from the herniation side. The possible mechanisms of how contralateral symptoms predominate in these patients are also discussed. In all patients, the shape of disk herniations on imaging studies were quite similar: a broad-based posterior central-paracentral herniated disk with the apex deviated away from the side of the symptoms. The symptoms and signs resolved in the immediate postoperative period. Our data clears that sciatica can be caused by contralateral lumbar disk herniation. When operation is considered, intervention only from the herniation side is sufficient. It is probable that traction rather than direct compression is responsible from the emergence of contralateral symptoms.

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

“…Anatomical anomalies of the ipsilateral nerve root with a high or low take-off may be protective against compressive forces. Conversely, anomalies of the contralateral nerve root, such as a conjoint origin or shorter lateral recess course, may render it more susceptible to compressive or tractional forces akin to the aetiology of the cervical C5 nerve root syndrome 2 4…”

“…Owing to the severity of his weakness, a decision was made for bilateral decompression and left-sided discectomy. Sucu and Gelal4 and Akdeniz et al 6 have suggested in their case series that discectomy on the side of the disc extrusion would be sufficient for resolution of the contralateral symptomatology, and this will be considered in future practices.…”

Lumbar disc herniation presenting with contralateral symptoms: a case report

“…Kornberg et al (13) proposed that inconsistent dural attachments to the posterior longitudinal ligaments holds the lumbar nerve roots at certain levels resulting in a more symptomatic traction of the contralateral nerve root. Sucu et al (10) in his series of 5 patients with paracentral disc herniation, suggested a similar mechanism resulting in compression of the contralateral nerve root against the facet joint. However these mechanisms have not been widely accepted.…”

“…The mechanism for lumbar disc herniation presenting with contralateral leg symptoms is poorly understood (10,11). Kornberg et al (13) proposed that inconsistent dural attachments to the posterior longitudinal ligaments holds the lumbar nerve roots at certain levels resulting in a more symptomatic traction of the contralateral nerve root.…”

A survey of the “medical” articles in the European Spine Journal, 2006

“…It creates a difficult therapeutic strategy when a surgical treatment is considered, the question being whether the disc herniation is really the cause of the symptoms. The paper by Sucu and Gelal [26], published in the May issue, raises an interesting discussion. Five patients with disc herniation and controlateral symptoms were operated at the side of the disc herniation without exploring the symptomatic side.…”