title: Surgical management of giant lumbar disc herniation: analysis of 154 patients over a decade.
abstract: BACKGROUND
  We describe a decade of our experience in the surgical management of patients with giant lumbar intervertebral disc herniation (GILID).
  
  
  METHODS
  This is a case series of patients operated for a GILID between 2000 and 2009. Among 1334 patients eligible for the present study: 154 patients presented with GILID (study group) and 1180 patients without GILID (control group). Clinical symptoms and preoperative imaging results were obtained from medical records. Complications and long-term results were assessed.
  
  
  RESULTS
  This retrospective study documents the characteristic features between patients with and without GILID. The difference in the incidence of female patients was statistically significant between the study group and the control group as was the mean duration of symptoms, hyperalgic radicular pain, bilaterality of symptoms, preoperative motor deficit, central location of lumbar disc herniation (LDH), contained herniation and recurrence of LDH.
  
  
  CONCLUSIONS
  GILIDs are a distinct entity: they are distinctly uncommon compared with smaller herniations, patients were statistically more likely to be hyperalgic with bilateral radicular pain and often associated with neurological deficits. The majority of patients do not display a cauda equina syndrome (CES). Low lumbar disc sites are mostly affected and disc fragments are more likely to be central-uncontained. The recurrence rate is lower for GILIDs.
authors.affiliation: Department of neurosurgery, Mohammed V military teaching hospital, university of Mohammed V Souissi, Rabat, Morocco; Department of neurosurgery, Avicenne military hospital, Marrakech, Morocco. Electronic address: akhaddar@hotmail.fr.
authors.forename: A
authors.initials: A
authors.lastname: Akhaddar
authors.affiliation: Department of neurosurgery, Mohammed V military teaching hospital, university of Mohammed V Souissi, Rabat, Morocco.
authors.forename: H
authors.initials: H
authors.lastname: Belfquih
authors.affiliation: Department of neurosurgery, Mohammed V military teaching hospital, university of Mohammed V Souissi, Rabat, Morocco.
authors.forename: M
authors.initials: M
authors.lastname: Salami
authors.affiliation: Department of neurosurgery, Mohammed V military teaching hospital, university of Mohammed V Souissi, Rabat, Morocco.
authors.forename: M
authors.initials: M
authors.lastname: Boucetta
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011128:Polyradiculopathy / Q000175:diagnosis / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cauda equina syndrome; Classification; Giant; Géant; Hernie discale lombaire; Lumbar disc herniation; Lumbar spine; Massive; Rachis lombaire; Syndrome de la queue de cheval