Radiculopathy Contralateral to the Side of Disc Herniation ―Microendoscopic Observation―

Introduction: There are patients with lumbar disc herniation (LDH) having contralateral sciatic symptoms although the mechanisms of this clinical feature are still not well understood. The purpose of this study was to investigate these mechanisms by microendoscopic findings. Methods: Patients were p...

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Main Authors: Norito Hayashi, Hideaki Iba, Kazuhiro Ohnaru, Kazuo Nakanishi, Toru Hasegawa
Format: Article
Language:English
Published: The Japanese Society for Spine Surgery and Related Research 2018-10-01
Series:Spine Surgery and Related Research
Subjects:
Online Access:https://www.jstage.jst.go.jp/article/ssrr/2/4/2_2017-0062/_pdf/-char/en
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author Norito Hayashi
Hideaki Iba
Kazuhiro Ohnaru
Kazuo Nakanishi
Toru Hasegawa
author_facet Norito Hayashi
Hideaki Iba
Kazuhiro Ohnaru
Kazuo Nakanishi
Toru Hasegawa
author_sort Norito Hayashi
collection DOAJ
description Introduction: There are patients with lumbar disc herniation (LDH) having contralateral sciatic symptoms although the mechanisms of this clinical feature are still not well understood. The purpose of this study was to investigate these mechanisms by microendoscopic findings. Methods: Patients were performed microendoscopic surgery using over-the-top approach (ME-OTT), with laminoplasty, extirpation of herniation, and observation of the contralateral nerve root. The over-the-top approach was applied through the same incision from the herniation side. Clinical results were assessed according to the clinical scoring system established by the Japanese Orthopedic Association (JOA) score. Results: This study consisted of five patients, with the average age of 55.6 years old. The mean preoperative JOA score was 13 points. Three cases were Grade II and two were Grade III degrees of disc herniation. Levels of herniation were one at L3-4 and four at L4-5. Remission of sciatic symptoms was obtained in all cases after surgery. The average and percent improvements (%IP) of JOA scores at 2 months after surgery were 27.8 points and 92%, respectively. By the approach from the herniation side using ME-OTT, image around the contralateral nerve root was obtained without radical intervention. By ME-OTT, redness of the nerve root and fibrosis around the symptomatic nerve root were identified, whereas inflammatory changes were not apparent on the ipsilateral nerve root. Conclusions: Operative treatment of LDH with contralateral symptoms by ME-OTT was a useful procedure for decompression and observation of the affected nerve root. Asymptomatic disc herniation, “silent disc herniation,” was considered at the herniation side since there were less inflammatory changes around the ipsilateral nerve root. In contrast, compression of dura toward the opposite side by disc herniation could have led to mechanical stress against the contralateral nerve root and triggered inflammation at lateral recess, resulting in radicular pain.
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spelling doaj.art-bb6cd1e256ac4878a30791dfc5c4d3612022-12-21T17:50:36ZengThe Japanese Society for Spine Surgery and Related ResearchSpine Surgery and Related Research2432-261X2018-10-012430430810.22603/ssrr.2017-00622017-0062Radiculopathy Contralateral to the Side of Disc Herniation ―Microendoscopic Observation―Norito Hayashi0Hideaki Iba1Kazuhiro Ohnaru2Kazuo Nakanishi3Toru Hasegawa4Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School HospitalDepartment of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School HospitalDepartment of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School HospitalDepartment of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School HospitalDepartment of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School HospitalIntroduction: There are patients with lumbar disc herniation (LDH) having contralateral sciatic symptoms although the mechanisms of this clinical feature are still not well understood. The purpose of this study was to investigate these mechanisms by microendoscopic findings. Methods: Patients were performed microendoscopic surgery using over-the-top approach (ME-OTT), with laminoplasty, extirpation of herniation, and observation of the contralateral nerve root. The over-the-top approach was applied through the same incision from the herniation side. Clinical results were assessed according to the clinical scoring system established by the Japanese Orthopedic Association (JOA) score. Results: This study consisted of five patients, with the average age of 55.6 years old. The mean preoperative JOA score was 13 points. Three cases were Grade II and two were Grade III degrees of disc herniation. Levels of herniation were one at L3-4 and four at L4-5. Remission of sciatic symptoms was obtained in all cases after surgery. The average and percent improvements (%IP) of JOA scores at 2 months after surgery were 27.8 points and 92%, respectively. By the approach from the herniation side using ME-OTT, image around the contralateral nerve root was obtained without radical intervention. By ME-OTT, redness of the nerve root and fibrosis around the symptomatic nerve root were identified, whereas inflammatory changes were not apparent on the ipsilateral nerve root. Conclusions: Operative treatment of LDH with contralateral symptoms by ME-OTT was a useful procedure for decompression and observation of the affected nerve root. Asymptomatic disc herniation, “silent disc herniation,” was considered at the herniation side since there were less inflammatory changes around the ipsilateral nerve root. In contrast, compression of dura toward the opposite side by disc herniation could have led to mechanical stress against the contralateral nerve root and triggered inflammation at lateral recess, resulting in radicular pain.https://www.jstage.jst.go.jp/article/ssrr/2/4/2_2017-0062/_pdf/-char/enlumbar disc herniationcontralateral symptommicroendoscopic surgeryfriction radiculitis
spellingShingle Norito Hayashi
Hideaki Iba
Kazuhiro Ohnaru
Kazuo Nakanishi
Toru Hasegawa
Radiculopathy Contralateral to the Side of Disc Herniation ―Microendoscopic Observation―
Spine Surgery and Related Research
lumbar disc herniation
contralateral symptom
microendoscopic surgery
friction radiculitis
title Radiculopathy Contralateral to the Side of Disc Herniation ―Microendoscopic Observation―
title_full Radiculopathy Contralateral to the Side of Disc Herniation ―Microendoscopic Observation―
title_fullStr Radiculopathy Contralateral to the Side of Disc Herniation ―Microendoscopic Observation―
title_full_unstemmed Radiculopathy Contralateral to the Side of Disc Herniation ―Microendoscopic Observation―
title_short Radiculopathy Contralateral to the Side of Disc Herniation ―Microendoscopic Observation―
title_sort radiculopathy contralateral to the side of disc herniation microendoscopic observation
topic lumbar disc herniation
contralateral symptom
microendoscopic surgery
friction radiculitis
url https://www.jstage.jst.go.jp/article/ssrr/2/4/2_2017-0062/_pdf/-char/en
work_keys_str_mv AT noritohayashi radiculopathycontralateraltothesideofdischerniationmicroendoscopicobservation
AT hideakiiba radiculopathycontralateraltothesideofdischerniationmicroendoscopicobservation
AT kazuhiroohnaru radiculopathycontralateraltothesideofdischerniationmicroendoscopicobservation
AT kazuonakanishi radiculopathycontralateraltothesideofdischerniationmicroendoscopicobservation
AT toruhasegawa radiculopathycontralateraltothesideofdischerniationmicroendoscopicobservation