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Massive lumbar disc herniation with complete dural sac stenosis
Chang-Hoon Jeon1, Nam-Su Chung, Kwang-Hyun Son
1Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea, South Korea.
Indian Journal of Orthopaedics
|June 27, 2013
Summary
Massive lumbar disc herniation (LDH) with complete dural sac stenosis causes severe pain but often resolves. Surgical intervention may be deferred unless significant neurological deficits arise.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Radiology
Background:
- Large lumbar disc herniation (LDH) is known for spontaneous resolution.
- Definitions of large LDH lack validation, and clinical symptoms are not fully understood.
- This study focuses on massive LDH with complete dural sac stenosis.
Purpose of the Study:
- To determine the clinical characteristics of massive LDH with complete dural sac stenosis.
- To evaluate the treatment outcomes for this specific condition.
- To clarify the clinical presentation and natural history of massive LDH.
Main Methods:
- Retrospective analysis of 33 patients with massive LDH and complete dural sac stenosis.
- Complete dural sac stenosis defined by MRI (no rootlet or CSF signal).
- Clinical outcomes assessed via pain scores, Oswestry Disability Index (ODI), and neurological function.
Main Results:
- Mean follow-up was 66 months.
- Patients presented with severe back (VAS 75.3) and leg pain (VAS 80.2), and high ODI (67.1).
- Neurological dysfunction occurred in 27.3% of patients; conservative treatment yielded satisfactory results in 63.6%.
Conclusions:
- Massive LDH with complete dural sac stenosis is linked to severe initial pain.
- Surgical treatment can often be postponed, especially if neurological symptoms are not significant.
- Conservative management can be effective for many patients with massive LDH.
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