目的:腰椎间盘突出症(LDH)是一种常见病理,通常与突出症同侧引起单侧神经根病,而患者可能偶尔出现对侧症状。由于罕见的LDH与对侧症状的发生率,病理机制尚不清楚,最佳手术策略是一个有争议的话题。这项研究旨在为对侧症状的病理机制提供新的见解,并评估该人群中同侧半椎板切除术和椎间盘切除术的疗效。
方法:本研究是一项回顾性研究,单中心,临床病例系列,包括11例仅对侧症状的LDH病例。我们搜索了2011年1月至2020年12月在我们机构就诊的LDH病例。成人LDH对侧根性疼痛患者包括在内,而那些患有同侧神经根病的人,腰椎管狭窄,症状侧的椎间孔狭窄,多节段椎间盘突出症,脊柱侧弯,并排除腰椎手术史。视觉模拟量表(VAS),临床特征,射线照相图像,和其他数据从11例病例的研究队列中收集,用于进一步分析.我们还回顾了1978年至2023年的英文文献中的LDH病例,以分析其临床特征和治疗。
结果:单级别LDH病例中伴有对侧症状的LDH发生率为0.32%。我们11例的平均年龄是49.3岁,其中五名为女性(45.5%)。所有个体都有单一水平的侧向LDH,其中6例(54.5%)位于L4-5,5例(45.5%)位于L5-S1。一被录取,患者出现下背部疼痛(7例,63.6%),神经根性疼痛(7例,63.6%),感觉减退(7例,63.6%),和肌肉无力(一例,9.1%)仅在对侧。每例都经历了同侧半椎板切除术和椎间盘切除术,没有外侧隐窝狭窄,小平面或韧带肥大,在手术中发现了隔离的椎间盘。所有患者均有良好的疼痛缓解,其中2例报告无疼痛,9例报告在最后一次随访时仅有轻度疼痛。
结论:根据我们11例有对侧症状的LDH的手术结果,我们假设对侧症状侧的神经根通过硬脑膜被突出的椎间盘紧紧牵拉时,可能会产生对侧症状。同侧半椎板切除术和椎间盘切除术有效且有效地缓解了这些患者的症状,而没有术后并发症。
OBJECTIVE: Lumbar disc herniation (LDH) is a common pathology that typically causes unilateral radiculopathy on the same side as herniation, while patients may occasionally present with contralateral symptoms. Owing to the rare incidence of LDH with contralateral symptoms, the pathological mechanism remains unclear and the optimal surgical strategy is a subject of debate. This study aimed to provide new insights into the pathological mechanism of contralateral symptoms and assess the efficacy of ipsilateral hemilaminectomy and discectomy surgery in this population.
METHODS: This study was a retrospective, single-center, clinical
case series, including 11 LDH cases with exclusive contralateral symptoms. We searched for LDH cases that were presented at our institution between January 2011 and December 2020. Adult LDH Patients with contralateral radicular pains were included, while those with ipsilateral radiculopathy, lumbar stenosis, foraminal stenosis on the symptomatic side, multilevel disc herniations, scoliosis, and lumbar operation history were excluded. Visual Analog Scale (VAS), clinical features, radiographic images, and other data were collected from the study cohort of 11 cases for further analysis. We also reviewed LDH cases in English literature from 1978 to 2023 to analyze their clinical characteristics and treatment.
RESULTS: The incidence rate of LDH with contralateral symptoms in single-level LDH cases was 0.32%. The average age of our 11 cases was 49.3 years old, and five of them were female (45.5%). All individuals had single-level lateral LDH, with six cases (54.5%) located at L4-5 and five cases (45.5%) located at L5-S1. Upon admission, patients presented with lower back pain (seven cases, 63.6%), radicular pain (seven cases, 63.6%), hypoesthesia (seven cases, 63.6%), and muscle weakness (one
case, 9.1%) on the contralateral side alone. Each
case experienced ipsilateral hemilaminectomy and discectomy, and no lateral recess stenosis, hypertrophy of facets or ligaments, and sequestrated discs were found during surgery. All of them have good pain relief with two cases reporting no pain and nine cases reporting only mild pain at the last follow-up.
CONCLUSIONS: Based on the surgical findings of our 11 LDH cases with contralateral symptoms, we hypothesized that the contralateral symptoms might be produced when the nerve root on the contralateral symptomatic side was tightly pulled by the herniated disc via the dural mater. Ipsilateral hemilaminectomy and discectomy surgery effectively and efficiently relieve the symptoms without postoperative complications for these patients.