Clinical features of extraforaminal lumbar disc herniation based on the radiographic location of the dorsal root ganglion.
METHODS
The relations between the location of the dorsal root ganglion and pre- and postoperative symptoms were reviewed retrospectively in 27 patients who underwent radiculography and posterior discectomy.


OBJECTIVE
To evaluate the clinical features and surgical outcome of extraforaminal lumbar disc herniation based on the location of dorsal root ganglion.


BACKGROUND
The location of dorsal root ganglia has been reported to be correlated with a variety of radicular symptoms. Extraforaminal lumbar disc herniation has several specific clinical features, one of which is severe radicular pain. However, there is no report in the literature on the association between the location of the dorsal root ganglia and the severity of the symptoms of extraforaminal lumbar disc herniation.


METHODS
The radiographic location of the dorsal root ganglion of each compressed nerve root was determined by preoperative direct radiculograms. All patients were classified into the following three groups according to the location of dorsal root ganglion: intraspinal, intraforaminal, and extraforaminal. The incidences of these locations were 5 of 27 (18.5%), 15 of 27 (55.5%), and 7 of 27 (25.9%), respectively. The relation between the location of the dorsal root ganglion and clinical parameters such as the level of the compressed nerve root, the degree of limitation on straight leg raising test, the severity of the pre- and postoperative subjective symptoms (leg pain, low back pain, and walking capacity), clinical signs (sensory and motor disturbance), and the recovery rate were investigated.


RESULTS
The degree of limitation on the straight leg raising test in the extraforaminal group tended to be low, compared with that in the intraspinal and intraforaminal groups. Low back pain in the extraforaminal group was more severe than that in the intraspinal and intraforaminal groups. Preoperative leg pain in the extraforaminal group was significantly more severe that that in the intraspinal group, and the walking capacity in the extraforaminal group tended to be lower than that in the intraspinal and intraforaminal groups. No significant differences were found between the location of dorsal root ganglion and the preoperative sensory or motor disturbance and surgical outcomes.


CONCLUSIONS
The location of the dorsal root ganglion might influence the severity of radicular symptoms (pain and walking distance tolerance) in patients with extraforaminal lumbar disc herniation.
Department of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Toyama, Japan. ohmori@ms.toyama-mpu.ac.jp
K
K
Ohmori
M
M
Kanamori
Y
Y
Kawaguchi
H
H
Ishihara
T
T
Kimura
D000328:Adult; D000368:Aged; D015984:Causality; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005727:Ganglia, Spinal / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011843:Radiculopathy / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D011859:Radiography; D016896:Treatment Outcome