Surgery for patients with central protruded lumbar discs who have failed conservative therapy

The clinical presentation and results of surgery of patients with central protruded lumbar discs have not been well defined or distinguished from studies of patients with lateral herniated discs. Many patients are denied surgical treatment, even though they are incapacitated by pain, because they do not have the classic radiographic findings seen in patients with lateral disc herniation. Sixty-three symptomatic patients with radiographically documented central lumbar disc protrusion were analysed. All patients had failed at least 6 months of conservative therapy. Although lumbar spinal pain was the most common complaint, 24 patients also presented with bilateral leg pain and 33 with unilateral leg pain; 26 had unilateral limitation of straight leg raising. An interesting observation was that unilateral symptoms and dural tension signs can be seen in patients with central disc protrusion. After surgical follow-up for a mean of 51 months, 86% achieved good results when analysed by the Prolo Functional Economic Outcome Rating Scale. It is postulated that pain is mediated by neuropeptides and arachidonic acid degradation products which are a response to mechanical annular injury.