Massive lumbar disc herniation with complete dural sac stenosis

Abstract

Background:Large lumbar disc herniation (LDH) has been reported to have a greater tendency to resolve in clinical and pathomorphological evolutions. However, various definitions of large LDH have been used without validation, and the clinical symptoms of large LDH have not been fully elucidated. We conducted a retrospective analysis to determine the clinical characteristics and treatment outcome of massive LDH with complete dural sac stenosisMaterials and Methods:We retrospectively reviewed 33 cases of LDH with complete dural sac stenosis on magnetic resonance imaging. Complete dural sac stenosis was defined as no recognizable rootlet and cerebrospinal fluid signal on T2-weighed axial MR images. The clinical outcome parameters included back pain, leg pain, Oswestry disability index (ODI), and neurological dysfunction. The paired t-test and Wilcoxon's signed rank test were used to compare serial changes in back pain, leg pain and neurological dysfunction.Results:Mean duration of followup was 66 months (range 24 - 108 months). There were 24 male and 9 female. The mean age was 37 years (range 20 - 53 years). At presentation, mean visual analogue scales for back pain and leg pain were 75.3 ± 19.1 (range 12 - 100) and 80.2 ± 14.6 (range 0 -100), respectively. Mean ODI was 67.1 ± 18.8 (range 26 - 88). Neurological dysfunction was found in 9 patients (27.3%), and the bowel/bladder dysfunction was found in 2 patients (3.1%). Conservative treatment was performed in 21 patients (63.6%) with satisfactory results. Seven patients underwent decompressive surgery, and 5 underwent posterolateral fusion.Conclusions:A massive LDH with complete dural sac stenosis was found to be associated with severe back and leg pain at presentation, however surgical treatment can be deferred unless significant neurological symptoms occur.

Does Size Matter? An Analysis of the Effect of Lumbar Disc Herniation Size on the Success of Nonoperative Treatment

“…Since, age, gender, race, and location also fail to show an association, our data suggests that all patients except those with cauda equina syndrome or a profound neurologic deficit should undergo 6 weeks of nonoperative management before surgery is considered. Jeon et al 23 arrived at a similar conclusion in their study. This point is emphasized by the similarities in the surgical and nonsurgical populations in this study, as illustrated in Table 1 .…”

Comparison of Functional Outcomes Between Lumbar Interbody Fusion Surgery and Discectomy in Massive Lumbar Disc Herniation: A Retrospective Analysis

“…3 - 5 ) Massive disc prolapse is defined on magnetic resonance imaging as a condition where herniated disc material occupies 50% or more anteroposterior diameter of spinal canal. 6 , 7 However, there are also published studies that show equivalent outcomes of conservative management of massive lumbar disc herniation on long-term follow-up. 8 The most common presenting symptom of massive disc herniation is radicular pain, may or may not associated with neurological deficit notably among them is cauda equina syndrome which needs urgent attention.…”

Massively prolapsed intervertebral disc herniation with interlaminar endoscopic spine system Delta endoscope: A case series

“…Several conventional surgeries, including simple fenestration discectomy, posterior lumbar interbody fusion (PLIF), and TLIF, are available for the treatment of massively prolapsed intervertebral disc herniation[ 6 , 13 , 14 ]. The operating field is relatively poor in simple fenestration discectomy, which could influence the stability of the zygopophysis and induce iatrogenic instability.…”

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