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Central lumbar disc herniation
C B Bärlocher1, J K Krauss, R W Seiler
1Department of Neurosurgery, Inselspital, University of Berne, Switzerland.
Insights
Central lumbar disc herniation (CLDH) outcomes are poorer than other types. Surgical approach and CLDH subcategories (CMP vs. CCDH) showed minimal impact on results.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Orthopedic Surgery
Background:
- Central lumbar disc herniation (CLDH) may be associated with poorer surgical outcomes compared to other lumbar disc herniations.
- The specific anatomical location of CLDH might influence postoperative results.
Purpose of the Study:
- To evaluate clinical outcomes in patients with CLDH.
- To determine if surgical approach (unilateral vs. bilateral) affects outcomes.
- To compare outcomes between central mass prolapse (CMP) and central contained disc herniation (CCDH) subcategories.
Main Methods:
- Retrospective analysis of 40 patients diagnosed with CLDH between 1990 and 1997.
- Patients underwent microdiscectomy via unilateral or bilateral fenestrations.
- Standardized questionnaires were used for long-term follow-up by an unbiased observer.
Main Results:
- 85% long-term follow-up (mean 3.3 years) was achieved for 34 patients.
- Overall success rate was 68%, with 24% excellent, 44% good, 24% fair, and 9% poor results.
- No significant differences in outcomes were found between CMP and CCDH, nor between unilateral and bilateral surgical approaches.
Conclusions:
- Postoperative outcomes for CLDH are generally poorer than for other lumbar disc herniations.
- The anatomical position of CLDH, affecting disc architecture, is a likely reason for poorer outcomes.
- Surgical approach and CLDH subcategories have minor impact; interlaminar fenestrations are suitable for fragment removal.
Unlabelled:
A follow-up study which describes the experience of the Department of Neurosurgery in Berne in the treatment of patients with central lumbar disc herniation (CLDH).
Background Data:
The anatomical position of lumbar disc herniation, in general, does not seem to affect postoperative outcome. However, according to other studies a subgroup of patients with central lumbar disc herniations appears to have poorer results.
Objectives:
The aim of the present study was to assess clinical outcome in a recent cohort of patients, to investigate whether there is a difference in outcome with regard to the surgical approach (unilateral vs bilateral) and to compare the postoperative results between the subcategories of CLDH: central massprolaps (CMP) and central contained disc herniation (CCDH).
Methods:
Between 1990 and 1997, 40 out of 3150 patients operated on for lumbar disc herniation were diagnosed with CLDH (1.2%). The patients were operated on through unilateral or bilateral fenestrations with microdiscectomy. Recent follow-up studies were obtained by standardized questionnaires. The retrospective investigation was performed by an unbiased observer.
Results:
Long-term follow-up was available for 34 of the 40 patients (85%) at a mean of 3.3 years. Eight patients had an excellent result (24%), 15 patients a good result (44%), 8 patients a fair (24%) and 3 patients had a poor result (9%). Overall, the operation was considered successful in 68% of patients. There was no statistically significant difference in outcome in patients with CMP as compared with those with CCDH (75% versus 64%). There was also no significant difference for better outcome between bilateral as compared with unilateral approaches.
Conclusions:
Postoperative outcome of central lumbar disc herniation (CLDH) is poorer as compared with other types of lumbar disc herniation. The reason seems to be the anatomical position of the disc herniation with a peculiar derangement of the disc architecture. The surgical approach itself or the subcategories of CLDH appear to have only minor impact on postoperative outcome. Interlaminar fenestrations, in general, are appropriate for removal of the disc fragments.