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

Young Do Koh; Seung Jun Rhee; Dong Jun Kim

doi:10.4184/JKSS.2010.17.4.169

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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

“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.

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Keywords: Discectomy, Central massive disc herniation, Instability

REFERENCES

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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)

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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)

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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’

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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
Level	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
Pre-op	VAS	8.83	8.85	0.991
1 months F/U	ODI	7.17	7.00	0.917
1 months F/U	VAS	2.42	2.46	0.954
2 years F/U	ODI	2.58	2.08	0.610
2 years F/U	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
1month F/U	Angular displacement(°)	11.96°	10.23°	0.351
2year F/U	Horizontal displacement(mm)	1.17mm	1.08mm	0.829
2year F/U	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

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