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Lumbar Disc Herniation with Contralateral Symptoms: A Case-Series of 11 Patients and Literature Review – Lumbar Spinal Stenosis

This article discusses lumbar disc herniation (LDH) with contralateral symptoms, which is a less common occurrence compared to unilateral radiculopathy. The aim of the study was to provide insight into the pathological mechanism of contralateral symptoms and evaluate the effectiveness of ipsilateral hemilaminectomy and discectomy surgery in these cases. The study included 11 LDH cases with exclusive contralateral symptoms, and data from these cases along with a review of LDH cases in the literature were analyzed. The results showed that the incidence rate of LDH with contralateral symptoms was 0.32% in single-level LDH cases. All 11 cases had single-level lateral LDH, with good pain relief reported after undergoing ipsilateral hemilaminectomy and discectomy surgery. The authors hypothesize that the contralateral symptoms may be caused by the herniated disc tightly pulling the nerve root on the contralateral symptomatic side. Overall, the study suggests that this surgical approach effectively relieves symptoms without postoperative complications for LDH patients with contralateral symptoms

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most specialised spine clinic in London

Published article

CONCLUSIONS: Based on the surgical findings of our 11 LDH cases with contralateral symptoms, we hypothesized that the contralateral symptoms might be produced when the nerve root on the contralateral symptomatic side was tightly pulled by the herniated disc via the dural mater. Ipsilateral hemilaminectomy and discectomy surgery effectively and efficiently relieve the symptoms without postoperative complications for these patients.

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Orthop Surg. 2023 Sep 25. doi: 10.1111/os.13849. Online ahead of print.ABSTRACTOBJECTIVE: Lumbar disc herniation (LDH) is a common pathology that typically causes unilateral radiculopathy on the same side as herniation, while patients may occasionally present with contralateral symptoms. Owing to the rare incidence of LDH with contralateral symptoms, the pathological mechanism remains unclear and the,

Orthop Surg. 2023 Sep 25. doi: 10.1111/os.13849. Online ahead of print.

ABSTRACT

OBJECTIVE: Lumbar disc herniation (LDH) is a common pathology that typically causes unilateral radiculopathy on the same side as herniation, while patients may occasionally present with contralateral symptoms. Owing to the rare incidence of LDH with contralateral symptoms, the pathological mechanism remains unclear and the optimal surgical strategy is a subject of debate. This study aimed to provide new insights into the pathological mechanism of contralateral symptoms and assess the efficacy of ipsilateral hemilaminectomy and discectomy surgery in this population.

METHODS: This study was a retrospective, single-center, clinical case series, including 11 LDH cases with exclusive contralateral symptoms. We searched for LDH cases that were presented at our institution between January 2011 and December 2020. Adult LDH Patients with contralateral radicular pains were included, while those with ipsilateral radiculopathy, lumbar stenosis, foraminal stenosis on the symptomatic side, multilevel disc herniations, scoliosis, and lumbar operation history were excluded. Visual Analog Scale (VAS), clinical features, radiographic images, and other data were collected from the study cohort of 11 cases for further analysis. We also reviewed LDH cases in English literature from 1978 to 2023 to analyze their clinical characteristics and treatment.

RESULTS: The incidence rate of LDH with contralateral symptoms in single-level LDH cases was 0.32%. The average age of our 11 cases was 49.3 years old, and five of them were female (45.5%). All individuals had single-level lateral LDH, with six cases (54.5%) located at L4-5 and five cases (45.5%) located at L5-S1. Upon admission, patients presented with lower back pain (seven cases, 63.6%), radicular pain (seven cases, 63.6%), hypoesthesia (seven cases, 63.6%), and muscle weakness (one case, 9.1%) on the contralateral side alone. Each case experienced ipsilateral hemilaminectomy and discectomy, and no lateral recess stenosis, hypertrophy of facets or ligaments, and sequestrated discs were found during surgery. All of them have good pain relief with two cases reporting no pain and nine cases reporting only mild pain at the last follow-up.

CONCLUSIONS: Based on the surgical findings of our 11 LDH cases with contralateral symptoms, we hypothesized that the contralateral symptoms might be produced when the nerve root on the contralateral symptomatic side was tightly pulled by the herniated disc via the dural mater. Ipsilateral hemilaminectomy and discectomy surgery effectively and efficiently relieve the symptoms without postoperative complications for these patients.

PMID:37749774 | DOI:10.1111/os.13849

The London Spine Unit : most specialised spine clinic in London

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Lumbar Disc Herniation with Contralateral Symptoms: A Case-Series of 11 Patients and Literature Review

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Orthop Surg. 2023 Sep 25. doi: 10.1111/os.13849. Online ahead of print.ABSTRACTOBJECTIVE: Lumbar disc herniation (LDH) is a common pathology that typically causes unilateral radiculopathy on the same side as herniation, while patients may occasionally present with contralateral symptoms. Owing to the rare incidence of LDH with contralateral symptoms, the pathological mechanism remains unclear and the
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