J Korean Soc Spine Surg.  2006 Jun;13(2):93-100. 10.4184/jkss.2006.13.2.93.

Clinical Outcome after Surgical Treatment of the Central Disc Herniation

• Lee JC
• Cho YI
• Nam JS
• Ji JW
• Kim YI
• Shin BJ

• KMID: 2097824
• DOI: http://doi.org/10.4184/jkss.2006.13.2.93

Abstract

STUDY DESIGN: This is a retrospective study
OBJECTIVE
We wanted to to assess the clinical features of central disc herniation and the differences in the clinical outcome between discectomy and fusion. Summary of the literature REVIEW: Central disc herniation appears to have poorer results than does posterolateral herniation in the literature. In most reports, persistent back pain was often found after discectomy and it may be related to the anatomical characteristics of the posterior longitudinal ligament in the lower lumbar region. MATERIALS AND METHOD: Central disc herniation was defined as a herniated mass that occupied more than 50% of the spinal canal and the maximal deviation of the apex was within 2 mm from the midline. 27 patients were operated on with using these criteria and they were subdivided by the operation methods. Laminotomy and discectomy was done in 20 patients. Posterior lumbar interbody fusions were performed on the other 7 patients with significant back pain. We compared the neurological improvement and the clinical outcomes.
RESULTS
Preoperative back pain was significantly more frequent in the PLIF group. The other clinical features were significantly improved in the both groups, but the differences were not statistically significant. Satisfactory clinical outcomes were obtained in 70 percent of the discectomy group and in 100 percent of the PLIF group, respectively, but this was not significantly different.
CONCLUSION
The presence of significant back pain was considered as an indication for performing fusion in our series. The clinical outcome of central disc herniation after PLIF was slightly better than that of discectomy in spite of the preoperative back pain in the PLIF group, but the difference was not statistically significant.

Keyword

Central disc herniation; Discectomy; Fusion; Lumbar

MeSH Terms

Back Pain
Diskectomy
Humans
Laminectomy
Longitudinal Ligaments
Lumbosacral Region
Retrospective Studies
Spinal Canal

Figure

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  Fig. 1. Definition of central lumbar disc herniation, which occupies more than 50% of the spinal canal. The apex of a herniated mass must be located in the midline of the spinal canal with a tolerance of 2 mm for deviation

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  Fig. 2. A 26 year-old female patient visited our clinic with radiating pain to right side lower extremity for 6 month. In initial anteroposterior roentgenogram, L4-5 disc space was decreased. Segmental instability was not revealed in the flexion-extension view. (A) In the magnetic resonance imaging, intervertebral disc signal of L4-5 was decreased and huge central disc herniation was observed. Dural sac at that level was significantly compressed. (B) At 1 year after laminotomy and discectomy, she complained of intermittent low back pain, especially at sitting position. On the flexion view, segmental kyphosis of L4-5 disc space was noted. (C)

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  Fig. 3. A 20 year-old male patient suffered for significant low back pain for 3 years and radiating pain to left lower extremity for 2 years. In initial flexion-extension view, focal hypermobility of L4-5 segment was noted. (A) Huge central disc herniation and indentation of dural sac was noted in the magnetic resonance images (B) and also in the myelogram (C). One year after posterior lumbar interbody fusion, his back pain and neurologic symptoms were disappeared. (D)

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