Clinical Research of Surgical Treatment for Extreme Lateral Lumbar Herniations.

概要

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From 1987 to 1993 we operated on eleven cases who had had extreme lateral lumbar disc herniations (ELLDH). All cases had severe leg pain and nine had low back pain. The severe leg pain was thought to be due to compression of the dorsal root ganglion and the spinal nerve. All cases had resisted conservative therapy. Regarding surgical method, lateral facetectomy was performed in seven cases, medial and lateral facetectomy in two cases, and osteoplastic laminectomy, unilateral facetectomy plus posterolateral fusion combined with instrumentation in one case each. All cases required microscopic surgical techniques.The results, using the Japan Orthopedic Association score (JOA score), shawed that the preoperative mean score of 5.1 improved to 12.1 postoperatively. We then compared two groups, group A were operated on within 30 days of developing symptoms, and Group B in which surgery was performed more than 31 days after developing symptoms. In regard to improvement in leg pain and percentage improvement. Group B was worse than Group A.We concluded that if the patients who had suffered ELLDH had severe leg pain, conservative therapy for relief of pain should be used first and if it fails, surgery should then be performed. We recommend the lateral procedure.
西日本整形・災害外科学会の論文