[Foraminal and extraforaminal lumbar disc herniations].
The severity of the clinical presentations of the foraminal or extraforaminal lumbar disc herniation (FLDH or EFLDH) and its response to conservative treatment were different. In order to make clear the reasons for that and then chose the best method of treatment, two types of FLDH or EFLDH were classified in a group of 23 cases according to the location of the protruded disc shown in the films of CT or MRI. Type I: the disc protruded up to the superior pedicle closely. Type II: the disc protruded laterally mainly with slight moving up. Then two subtypes were made, subtype a: symple FLDH or EFLDH: subtype b: if combined with posterior lateral disc herniation. In total of 23 cases there were 10 of type (I a: 8, I b: 2) and 13 of type II (II a: 7, II b: 6), among of which there were 14 FLDHs and 9 EFLDHs. The clinical presentations and the results of conservative treatment were compared between the two types. The results of statistical analysis showed that the severity of damage to the nerve root and its response to conservative treatment were mainly related to the location of the protruded disc to the superior pedicle rather than the protruded disc in the foramen or extraforamen. All of cases of type I had more severe symptoms and signs, poorer results of conservative treatment and were operated on finally. However some cases of type II only had slight or even no symptoms and signs at all, 50% of the patients in the type II were cured by nonsurgical methods. So it was suggested that the cases of type I be treated surgically mainly, whereas the type II initially be treated conservatively and if failed, go to operation. The approach lateral to the pars interarticularis for the discectomy had more advantages than the other methods and could be applied in most of cases. If combined posterior lateral disc herniation was the main pathologic change in the cases of type II laminectomy with partial facetectomy might be used. The classification is reliable as it is well consisten with the findings of operations. So it is valuable for the guidance of determining the method of nonsurgical or surgical treatment.
Chen
Z
Z
Third Teaching Hospital, Beijing Medical University.
Dang
G
G
D000328:Adult; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000145:classification* / Q000601:surgery / Q000628:therapy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged