J Korean Neurosurg Soc.  2016 Mar;59(2):143-148. 10.3340/jkns.2016.59.2.143.

Postoperative Clinical Outcome and Risk Factors for Poor Outcome of Foraminal and Extraforaminal Lumbar Disc Herniation

• Bae JS
• Kang KH
• Park JH
• Lim JH
• Jang IT

• KMID: 2192044
• DOI: http://doi.org/10.3340/jkns.2016.59.2.143

Abstract

OBJECTIVE
We evaluated postoperative outcomes in patients who have lumbar foraminal or extraforaminal disc herniation (FELDH) and suggested the risk factors for poor outcomes.
METHODS
A total of 234 patients were selected for this study. Pre- and post-operative Visual Analogue Scale (VAS) and Korean version Oswestry Disability Index (KODI) were evaluated and the changes of both score were calculated. Outcome was defined as excellent, good, fair, and poor based on Mcnab classification. The percentage of superior facetectomy was calculated by using the Maro-view 5.4 Picture Archiving Communication System (PACS).
RESULTS
Paramedian lumbar discectomy was performed in 180 patients and combined lumbar discectomy was performed in 54 patients. Paramedian lumbar discectomy group showed better outcome compared with combined discectomy group. p value of VAS change was 0.009 and KODI was 0.013. The average percentage of superior facetectomy was 33% (range, 0-79%) and it showed negative correlation with VAS and KODI changes (Pearson coefficient : -0.446 and -0.498, respectively). Excellent or good outcome cases (Group I) were 136 (58.1%) and fair or poor outcome cases (Group II) were 98 (41.9%). The percentage of superior facetectomy was 26.5% at Group I and 42.5% at Group II. There was significant difference in superior facetectomy percentage between Group I and II (p=0.000).
CONCLUSION
This study demonstrated that paramedian lumbar discectomy with preservation of facet joints is an effective and good procedure for FELDH. At least 60% of facet should be preserved for excellent or good outcomes.

Keyword

Far-lateral disc herniation; Paraspinal approach; Double herniation

MeSH Terms

Classification
Diskectomy
Humans
Risk Factors*
Zygapophyseal Joint

Figure

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  Fig. 1 Cross sectional areas of facet joint were check between three lines (a : upper endplate, b : disc space, c : lower endplate).

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  Fig. 2 The calculation tool of cross sectional area of the facet joint.

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  Fig. 3 Right L5 nerve root was impinged between alar transverse process and laterally bulged disc.

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  Fig. 4 Highly-lying ala transverse process (arrow).

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  Fig. 5 Foraminal view MRI of L5–S1 right side.

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