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KMID : 0376419960200010089
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Chonbuk University Medical Journal
1996 Volume.20 No. 1 p.89 ~ p.96
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Diagnosis and Sugical Approach ot Far Lateral Lumbar Disc Heriniation
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Abstract
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Lumbar disc herniation into and beyond the neural foramen may present difficult diagnostic and therapeutic considerations for the neurosurgeon. Surgical intervention predicted primarily on the clinical picture may lead to exploration of the
incorrect
level. To incomplete exploration or tounnecessary additional interspace exposure, any of which may produce the failed back syndrome. In far lateral lumbar disc herniation, the myelography usually shows negative findings and high resolution CT is
best
method of diagnostic modality. Sometimes it was confirmed only by the discographic CT. If these herniations are diagnosed, they often cannot be adequately exposed by the classic midline approach. A partial or complete unilateral facetectomy to
expose
these herniations can lead to vertebral instability or contribute to continued postoperative back pain.
The authors present 7 patients diagnosed as having far lateral lumbar disc herniation from Jan. 1994 to Dec. 1995.
Main symptoms relating to far lateral LDH consist of severe radiating leg pain, hypethesia and aggravation of leg pain during lateral tilting of lumbar spine toward the lesion side. Straight raising test(SLRT) was negative in three cases.
Two cases who were difficult to be diagnosed, with lumbar CT or MRI could be diagnosed with discographic CT. PHL with medial facetectomy was useful for foraminal type and paramedian approach for extraforaminal type However, paramedian approach
with
PHL
was useful for combined types of lesion. All the patients with far lateral LDH showed the satisfactory results: excellent in six, good in one.
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