Relative Risk of Operation between Lumbar Far Lateral Disc Herniation and Posterolateral Disc Herniation: A Retrospective Cohort Study

Dae Ho Ha; Dae Moo Shim; Tae Kyun Kim; Sung Kyun Oh; Jin Kim

doi:10.4055/jkoa.2017.52.5.442

Journal List > J Korean Orthop Assoc > v.52(5) > 1013551

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Ha, Shim, Kim, Oh, and Kim: Relative Risk of Operation between Lumbar Far Lateral Disc Herniation and Posterolateral Disc Herniation: A Retrospective Cohort Study

Original Article

Journal of the Korean Orthopaedic Association 2017; 52(5): 442-447.

Published online: 30 October 2017

DOI: https://doi.org/10.4055/jkoa.2017.52.5.442

Relative Risk of Operation between Lumbar Far Lateral Disc Herniation and Posterolateral Disc Herniation: A Retrospective Cohort Study

Dae Ho Ha, M.D., Dae Moo Shim, M.D.^*, Tae Kyun Kim, M.D.^*, Sung Kyun Oh, M.D., Jin Kim, M.D.

Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Gunpo, Korea.

^*Department of Orthopaedic Surgery and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.

Correspondence to: Sung Kyun Oh, M.D. Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, 327 Sanbon-ro, Gunpo 15865, Korea. TEL: +82-31-390-2224, FAX: +82-31-398-2223, niceo@hanmail.net

Received 25 November 2016 Revised 3 January 2017 Accepted 20 March 2017

The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We reported relative risk of operation between patients who were diagnosed with lumbar far lateral disc herniation and posterolateral disc herniation after transforaminal epidural block.

Materials and Methods

A retrospective cohort study was performed on 295 patients (131 male and 164 female) who underwent transforaminal epidural block for unilateral radiculopathy caused by lumbar intervertebral disc herniation. Among these 295 patients, 34 patients were diagnosed with far lateral disc herniation and 261 patients with posterolateral disc herniation. The median follow-up period was 23.9 months, with an average age of 55.7 years.

Results

Fifty-one patients underwent surgical treatment. Among them, 38 patients had posterolateral disc herniation and 13 patients had far lateral disc herniation. Patients with far lateral disc herniation, when compared with posterolateral disc herniation, had a relative risk of operation of 2.67 (1.59-4.48, 95% confidence interval) with statistical significance (p=0.0002). At the final follow-up, the average visual analogue scale (VAS) score for radicular pain in the surgical and non-surgical groups was 0.69 and 1.50, respectively; the average Korean-Oswestry Disability Questionnaire (K-ODI) score was 11.7 and 9.6, respectively. The difference of average VAS score showed a statistical significance (p=0.035), however, that of K-ODI showed no statistical significance (p=0.266).

Conclusion

In the case of far lateral disc herniation, the relative risk of surgery after transforaminal epidural block was 2.67, which is higher than that of posterolateral disc herniation. Therefore, we should consider surgical treatment more aggressively.

Keywords: spine, discectomy, epidural injections

Figures and Tables

Figure 1

Results of retrospective cohort. MRI, magnetic resonance imaging; P/ex, physical exam; Op +, operation (+); Op –, operation (–).

Table 1

Demographic Data of Patients

Values are presented as number only or mean only.

Table 2

Results of Each Group

Values are presented as number only, mean only, or number (%).

Table 3

Relative Risk of Operation for far Lateral Disc Herniation Patients

CI, confidence interval; NNT, number needed to treat.

Table 4

Clinical Outcomes of Patients with Lumbar Far Lateral Disc Herniation Patients

Values are presented as mean±standard deviation. VAS, visual analogue scale; K-ODI, Korean-Oswestry Disability Questionnaire.

Notes

This research was supported by grant from Wonkwang University, 2017.

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

References

1. Epstein NE. Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures. Spinal Cord. 2002; 40:491–500.

2. Epstein NE. Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results. J Neurosurg. 1995; 83:648–656.

3. Ahn MW, Kim US, Kim GB. Usefulness of the ProSet MRI for diagnosis of the extraforaminal disc herniation. J Korean Soc Spine Surg. 2013; 20:28–33.

4. Epstein NE. Different surgical approaches to far lateral lumbar disc herniations. J Spinal Disord. 1995; 8:383–394.

5. Rust MS, Olivero WC. Far-lateral disc herniations: the results of conservative management. J Spinal Disord. 1999; 12:138–140.

6. Altman DG. Practical statistics for medical research. London: Chapman and Hall;1991.

7. Shin BJ, Lee JC, Lee HH, Jang HD. Conservative treatment of lumbar disc herniation: a prospective study of disc herniation encroaching more than one-third of spinal canal. J Korean Soc Spine Surg. 2011; 18:123–131.

8. Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine (Phila Pa 1976). 1983; 8:131–140.

9. Saal JA. Natural history and nonoperative treatment of lumbar disc herniation. Spine (Phila Pa 1976). 1996; 21:2S–9S.

10. Weiner BK, Fraser RD. Foraminal injection for lateral lumbar disc herniation. J Bone Joint Surg Br. 1997; 79:804–807.

11. Kim MH, Suh KJ, Lee JY, Min SH, Yoo HY. Usefulness of coronal MR image in diagnosis of foraminal and extraforaminal disc herniation. J Korean Soc Spine Surg. 2008; 15:165–173.

12. Cho YW. Effect of intensive conservative treatment on extraforaminal lumbar disc herniations: 1 year prospective follow-up study. J Korean Acad Rehabil Med. 2009; 33:89–93.

13. Phan K, Dunn AE, Rao PJ, Mobbs RJ. Far lateral microdiscectomy: a minimally-invasive surgical technique for the treatment of far lateral lumbar disc herniation. J Spine Surg. 2016; 2:59–63.

14. Faust SE, Ducker TB, VanHassent JA. Lateral lumbar disc herniations. J Spinal Disord. 1992; 5:97–103.

TOOLS

Similar articles