Foraminal lumbar disc herniation. Experience with 83 patients

Area of Science:

• Neurosurgery
• Spinal Surgery
• Radiology

Background:

• Foraminal lumbar disc herniation (FLDH) clinical presentation is debated, with some authors reporting a specific syndrome while others find it indistinguishable from posterolateral herniations.
• Surgical approaches, including interlaminar and extra-articular, are frequently compared for managing FLDH.

Purpose of the Study:

• To define clinical and radiologic diagnostic criteria for FLDH.
• To evaluate the efficacy of interlaminar and extra-articular surgical exposures.
• To assess postoperative outcomes in patients with FLDH.

Main Methods:

• Analysis of 83 patients surgically treated for FLDH.
• Review of clinical findings and preoperative imaging, including computed tomography (CT) and CT discography for a subset of patients.
• Evaluation of surgical approaches: interlaminar with partial medial facetectomy (73 patients) and extra-articular (10 patients).
• Postoperative assessment over a 2-year follow-up period.

Main Results:

• FLDH exhibits a specific clinical picture, often with severe radicular signs.
• Accurate preoperative radiologic diagnosis is crucial for surgical success.
• 76% of patients achieved good postoperative results; others experienced mild residual radicular pain without evidence of root compression on CT.
• Only 21% of patients with preoperative radicular deficits experienced a full recovery.

Conclusions:

• FLDH has characteristic clinical features necessitating specific diagnostic approaches.
• High-resolution CT, CT discography, or MRI are essential for accurate radiologic diagnosis of FLDH.
• The interlaminar approach, extended to the upper lamina and medial facet without total facetectomy, is suitable for most FLDH cases.
• Extra-articular approaches should be reserved for extra-foraminal herniations.