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Related Experiment Video

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Extraforaminal Lumbar Disk Herniations Lead To Neuroplastic Changes: a Study Using Quantitative Sensory Testing.

Anja Tschugg1, Sara Lener1, Sebastian Hartmann1

  • 1Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria.

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|July 21, 2018
PubMed
Summary

Extraforaminal lumbar disk herniations show distinct pain signaling differences compared to intraspinal herniations. This suggests extraforaminal compression may promote specific chronic neuropathic pain mechanisms.

Keywords:
extraforaminal lumbar disk herniationlumbar disk herniationlumbar radiculopathylumbar sequestrectomyneuropathic painquantitative sensory testing

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Area of Science:

  • Neurology
  • Pain Medicine
  • Neurosurgery

Background:

  • Lumbar disk herniations (LDH) present with varied clinical symptoms.
  • Extraforaminal LDH are less common but may have unique pain characteristics compared to paramedian LDH.

Purpose of the Study:

  • To investigate differences in pain modulation and sensory processing between extraforaminal and intraspinal LDH.
  • To explore the potential mechanisms underlying neuropathic pain in extraforaminal LDH.

Main Methods:

  • Quantitative Sensory Testing (QST) was applied to 63 patients with single LDH.
  • Patients were categorized into intraspinal (Group I) and extraforaminal (Group E) herniation groups.
  • Pain modulation was assessed using the wind-up ratio and numeric rating scale following pinprick stimuli.

Main Results:

  • The wind-up ratio, indicating endogenous pain modulation, was significantly higher in the extraforaminal group (Group E) compared to the intraspinal group (Group I).
  • Group E also demonstrated a greater increase in pain intensity after pinprick stimuli compared to Group I.
  • These findings suggest altered pain processing in patients with extraforaminal LDH.

Conclusions:

  • Extraforaminal lumbar disk herniation is associated with distinct pain signaling pathways.
  • Direct compression of the dorsal root ganglion in extraforaminal LDH may contribute to chronic neuropathic pain mechanisms.
  • Further research into these mechanisms could inform targeted pain management strategies.