J Korean Soc Spine Surg.  2010 Dec;17(4):169-176. 10.4184/jkss.2010.17.4.169.

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

• Koh YD
• Rhee SJ
• Kim DJ

• KMID: 2209579
• DOI: http://doi.org/10.4184/jkss.2010.17.4.169

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.

Keyword

Discectomy; Central massive disc herniation; Instability

MeSH Terms

Axis, Cervical Vertebra
Case-Control Studies
Diskectomy
Humans
Intervertebral Disc Displacement
Retrospective Studies
Spinal Canal

Figure

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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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