J Korean Neurosurg Soc.  2017 Feb;60(2):220-224. 10.3340/jkns.2016.1010.015.

Lumbar Disc Herniation Presented with Contralateral Symptoms

• Kim P
• Ju CI
• Kim HS
• Kim SW

• KMID: 2374884
• DOI: http://doi.org/10.3340/jkns.2016.1010.015

Abstract

OBJECTIVE
This study aimed to unravel the putative mechanism underlying the neurologic deficits contralateral to the side with lumbar disc herniation (LDH) and to elucidate the treatment for this condition.
METHODS
From January 2009 to June 2015, 8 patients with LDH with predominantly contralateral neurologic deficits underwent surgical treatment on the side with LDH with or without decompressing the symptomatic side. A retrospective review of charts and radiological records of these 8 patients was performed. The putative mechanisms underlying the associated contralateral neurological deficits, magnetic resonance imaging (MRI), electromyography (EMG), and the adequate surgical approach are discussed here.
RESULTS
MRI revealed a similar laterally skewed paramedian disc herniation, with the apex deviated from the symptomatic side rather than directly compressing the nerve root; this condition may generate a contralateral traction force. EMG revealed radiculopathies in both sides of 6 patients and in the herniated side of 2 patients. Based on EMG findings and the existence of suspicious lateral recess stenosis of the symptomatic side, 6 patients underwent bilateral decompression of nerve roots and 2 were subjected to a microscopic discectomy to treat the asymptomatic disc herniation. No specific conditions such as venous congestion, nerve root anomaly or epidural lipomatosis were observed, which may be considered the putative pathomechanism causing the contralateral neurological deficits. The symptoms resolved significantly after surgery.
CONCLUSION
The traction force generated on the contralateral side and lateral recess stenosis, rather than direct compression, may cause the contralateral neurologic deficits observed in LDH.

Keyword

Lumbar; Herniated disk; Contralateral

MeSH Terms

Constriction, Pathologic
Decompression
Diskectomy
Electromyography
Humans
Hyperemia
Intervertebral Disc Displacement
Lipomatosis
Magnetic Resonance Imaging
Neurologic Manifestations
Radiculopathy
Retrospective Studies
Traction

Figure

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  Fig. 1 A 67-year-old male patient presented with right leg motor weakness. A and B: T2-weighted sagittal and axial magnetic resonance images show left paracentral disc herniation with the apex deviated to the left.

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  Fig. 2 A 50-year-old male patient presented with right leg pain. A and B: T2-weighted sagittal and axial magnetic resonance images reveal left paracentral disc herniation with the apex deviated to the left. Neither of the nerve roots are directly compressed.

Reference

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