Journal List > J Korean Soc Spine Surg > v.17(4) > 1075910

TOOLS
Koh, Rhee, and Kim: Radiological and Clinical Outcome after Simple Discectomy of Central Massive Lumbar Disc Herniation
Original Research

J Korean Soc Spine Surg 2010;17(4):169-176.

Published online: 18 December 2010

DOI: https://doi.org/10.4184/JKSS.2010.17.4.169

Radiological and Clinical Outcome after Simple Discectomy of Central Massive Lumbar Disc Herniation

Young Do Koh, M.D., Seung Jun Rhee, M.D., Dong Jun Kim, M.D.

Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Korea

Corresponding author: Dong Jun Kim, M.D. Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University, School of Medicine, 911-1, mok 6-dong, Yangcheon-gu, Seoul 158-710, Seoul, Korea TEL: 82-2-2650-2873, FAX : 82-2-2642-0349 E-mail: oskdj@ewah.ac.kr

Received 16 July 201010 December 2010       Accepted 10 December 2010

© Copyright 2010 Korean Society of Spine Surgery

“This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.”

Abstract

Study Design

This is a retrospective case control study.

Objectives

To analyze our results following simple discectomy of central massive disc herniation focusing on instability for the usefulness of intervertebral fusion.

Summary of Literature Review

Lumbar instability is a complication of central massive disc herniation. However, there is limited evidence on the correlation between lumbar instability and loss of disc material.

Materials and Methods

A total of 25 patients who had undergone discectomy for a single-level lumbar disc herniation were followed up for two years. The clinical group (group A) included 12 patients that had a compromised canal with greater than 50% of the herniated disc, while the central axis of the herniated disc was less than 20% deviated from the center axis of the spinal canal, as seen on MRI. The control group (group B) had 13 patients that had a compromised canal with less than 50% of the herniated disc while their axis was more than 20% deviated from the center axis of the spinal canal. Clinical and radiologic instability, pain and functional disability were compared between the two groups.

Results

No differences was found between the two groups in clinical instability, radiological instability, visual analogue scale (VAS), and the Oswestry disability index (ODI).

Conclusions

Central massive disc herniation after discectomy did not show a significant difference in clinical or radiological instability from that of other herniation types.

Keywords: Discectomy, Central massive disc herniation, Instability

REFERENCES

1.Knutsson F. The instability associated with disk degeneration of the lumbar spine. Acta Radiol Scand. 1944. 25:593–609.
2.Dupis PR., Yong-Hing K., Cassidy JD., Kirkaldy Willis WH. Radiologic diagnosis of lumbar spinal instability. Spine. 1985. 10:262–76.
3.Nachlas IW. End-results study of the treatment of herniated nucleus pulposus by excision with fusion and without fusion. J Bone Joint Surg Am. 1952. 34:981–8.
4.Barr JS., Kubik GS., Molloy MK, et al. Evaluation of end results in treatment of ruptured lumbar intervertebral discs with protrusion of nucleus pulposus. Surg Gynecol Obstet. 1967. 125:250–6.
5.Frymoyer JW., Hanley E., Howe J., Kuhlmann D., Matteri R. Disc excision and spine fusion in the management of lumbar disc disease: A minimum ten-year follow-up. Spine. 1978. 3:1–6.
6.LaMont RL., Morawa LG., Pederson HE. Comparison of disc excision with combined disc excision and spinal fusion for lumbar disc ruptures. Clin Orthop. 1976. 121:212–6.
7.Rish BL. A comparative evaluation of posterior lumbar interbody fusion for disc disease. Spine. 1985. 10:855–7.
crossref
8.Vaughan PA., Malcolm BW., Maistelli GL. Results of L4–L5 disc excision alone versus disc excision and fusion. Spine. 1988. 13:690–5.
crossref
9.Young HH., Love GJ. End results of removal of protruded lumbar intervertebral discs with and without fusion. Am Acad Orthop Surg Inst Course Lecture. 1959. 16:213–6.
10.Takeshima T., Kambara K., Miyata S., Ueda Y., Tamai S. Clinical and radiographic evaluation of disc excision for lumbar disc herniation with and without posterolateral fusion. Spine. 2000. 25:450–6.
crossref
11.Satoh I., Yonenobu K., Hosono N., Ohwada T., Fuji T., Yoshikawa H. Indication of posterior lumbar interbody fusion for lumbar disc herniation. J Spinal Disord Tech. 2006. 19:104–8.
crossref
12.Tominaga S., Date K., Ouchi K, et al. Comparison between nonfusion and fusion group for lumbar discopathy—Effects of intervertebral fusion. Rinshou Seikei Geka. 1988. 23:236–46.
13.White AH., von Rogov P., Zucherman J., Heiden D. Lumbar laminectomy for herniated disc; a prospective controlled comparison with internal fixationfusion. Spine. 1987. 12:305–7.
14.Eie N. Comparison of the results in patients operated upon for ruptured lumbar discs with and without spinal fusion. Acta Neurochir (Wien). 1978. 41:107–13.
crossref
15.Barr JS. Low back and sciatic pain: Result of treatment. J Bone Joint Surg Am. 1951. 33:633–49.
16.Burns BH., Young RH. Results of surgery in sciatica and low back pain. Lancet. 1951. 257:245–9.
crossref
17.Decker HG., Shapiro SW. Herniated lumbar intervertebral disks; results of surgical treatment without the routine use of spinal fusion. AMA Arch Surg. 1957. 75:77–84.
18.Frymoyer JW., Hanley EN Jr., Howe J., Kuhlmann D., Matteri RE. A comparison of radiographic findings in fusion and nonfusion patients ten or more years following lumbar disc surgery. Spine. 1979. 4:435–40.
crossref
19.Weber H. Lumbar disc herniation: a controlled, prospective study with ten years of observation. Spine. 1983. 8:131–40.
crossref
20.GL Cribb, DC Jaffray, VN Cassar pullicino. Observation on the natural history of massive lumbar disc herniation. J Bone Joint Surg Br. 2007. 89:782–4.
21.Barlocher CB., Krauss JK., Seiler RW. Central lumbar disc herniation. Acta Neurochir (wien). 2000. 142:1369–75.
22.Knop-Jergas BM., Zucherman JF., Hsu KY., DeLong B. Anatomic position of a herniated nucleus pulposus predicts the outcome of lumbar discectomy. J Spinal Disord. 1996. 9:246–50.
crossref
23.Walker JL., Schulak D., Murtagh R. Midline disc herniation of the lumbar spine. Southern Med J. 1993. 86:13–7.
24.Ki SC., Choi YS., Kim KS., Kuk WJ. Lumbar Discectomy Using Tubular Retractor and Microendoscopy. J Korean Soc Spine Surg. 2008. 15:265–71.
crossref
25.Chung YK., Yoo JH., Chung KJ., Wang JS. Clinical results of percutaneous endoscopic discectomy in herniated intervertebral disc of lumbar spine. J Korean Soc Spine Surg. 2005. 12:224–8.
crossref
26.Lee KY., Sohn SK., Lee MJ., Chung IK. The influence of the degree of lumbar disc degeneration on MRI and the amount of removed disc on clinical outcomes. J Korean Soc Spine Surg. 2005. 12:184–91.
crossref

Fig. 1.
MRI finding of disc herniation and the method of canal compromised area. A Canal compromised (%) = A/A+B × 100 BA (A + B : spinal canal area, A : involved canal area)
jkss-17-169f1.tif
Fig. 2.
Axial lateralization of disc herniation in MRI Axial lateralization (%) = B/A ⨯ 100 (A : radius of spinal canal, B : length from canal center to axis of herniated disc)
jkss-17-169f2.tif
Fig. 3.
Measurement of angular difference and horizontal displacement on flexion/extension radiogram (Radiographic method of Dupuis and co-workers) Horizontal displacement = AO – RO Angular displacement = θ”-θ’
jkss-17-169f3.tif
Table 1.
Constitution of the clinical group and control group
    Group A     GroupB  
Case (no.)   12     13  
Sex (M:F)   3 : 9     11:2  
Age (years)   39.75     41.69  
Canal compromised (%)   71.06     27.47  
Axis lateralization rate (%)   7.83     59.77  
Level L4-L5   L5-S1 L4-L5   L5-S1
11   1 4   9

∗ Group A; clinical group with canal compromised more than 50% and with axis lateralization rate less than 20% in MRI

∗ Group B; control group with canal compromised less than 50% and with axis lateralization rate more than 20% in MRI

Table 2.
Clinical result of clinical group and control group
    Group A GroupB p-value
Pre-op ODI 32.08 32.15 0.972
VAS 8.83 8.85 0.991
1 months F/U ODI 7.17 7.00 0.917
VAS 2.42 2.46 0.954
2 years F/U ODI 2.58 2.08 0.610
VAS 0.83 0.85 0.969

∗Group A; clinical group with canal compromised more than 50% and with axis lateralization rate less than 20% in MRI

∗Group B; control group with canal compromised less than 50% and with axis lateralization rate more than 20% in MRI

†.ODI : Oswestry disability index

‡.VAS : Visual analogue scale

Table 3.
Radiological result of clinical group and control group.
    Group A Group B p-value
1month F/U Horizontal displacement(mm) 2.54mm 1.80mm 0.276
Angular displacement(°) 11.96° 10.23° 0.351
2year F/U Horizontal displacement(mm) 1.17mm 1.08mm 0.829
Angular displacement(°) 6.29° 7.50° 0.368

∗ Group A; clinical group with canal compromised more than 50% and with axis lateralization rate less than 20% in MRI

∗ Group B; control group with canal compromised less than 50% and with axis lateralization rate more than 20% in MRI

TOOLS
Similar articles