CLINICAL-APPEARANCE OF CONTAINED AND NON-CONTAINED LUMBAR DISC HERNIATION

In a prospective and consecutive study, we evaluated the incidence of common symptoms and neurologic disturbances in 200 patients operated o n because of lumbar disc herniation by using a computer-coded protocol with pre- and perioperative registration. The preoperative occurrence of pain at rest, at night, and on coughing was registered. Use of ana lgesics and walking ability were registered as category data. At exami nation, a straight-leg-raising (SLR) test was graded in four categorie s, and results from neurologic findings were collected. At surgery, di sc hemiation was classified as extruded/sequestered hemiation, prolaps e, or focal protrusion. There were no significant differences concerni ng pain at rest or at night related to type of herniation. Pain on cou ghing was more common in extruded/sequestered herniations. Use of anal gesics as well as severe reduction of walking capacity were significan tly more common in patients with extrusion/sequestration. The highly r estricted SLR test, as well as the crossed positive SLR test, were als o significantly more common in patients with extruded/sequestered hern iation, and this was also true for the incidence of relevant reflex/ex tensor hallucis longus (EHL) and sensory disturbance. In conclusion, t he clinical appearance of lumbar disc herniation was most ''aggressive '' in extruded and sequestered disc herniation. The symptoms and signs in disc protrusion were less severe, whereas patients with prolapse h ad an ''intermediate'' appearance concerning symptoms and signs. The d ifferences in incidence of common signs in noncontained versus contain ed herniation were statistically significant; these differences may be of clinical interest for patient selection and information as well as in pathophysiologic considerations.