FORAMINAL LUMBAR DISC HERNIATION - EXPERIENCE WITH 83 PATIENTS

Study Design. This study analyzed a series of 83 patients operated on for foraminal lumbar disc herniation. Objectives. This study sought to develop clinical and radiologic diagnoses, evaluate interlaminar and extra-articular exposures, and evaluate postoperative results. Summary of Background Data, Some authors have reported a specific clinical sy ndrome, but other reports have indicated the clinical picture is indis tinguishable from usual posterolateral disc herniation. Surgical manag ement often has been compared between the interlaminar and extra-artic ular approaches.Methods. Clinical findings were reviewed. All patients were evaluated with computed tomography, but radiologic diagnosis req uired computed tomographic discography for 26 patients. Interlaminar e xposure with partial medial facetectomy was performed in 73 patients a nd an extra-articular approach was necessary in 10 patients. Postopera tive results were evaluated with a 2-year follow-up. Results. Foramina l lumbar disc herniations have a specific clinical picture, particular ly severe radicular signs. Precise preoperative radiologic evaluation is essential for successful operative procedure. Postoperative results were good in 76% of the patients. The other patients felt mild residu al radicular pain, although no residual root compression was found on postoperative computed tomography. Only 21% of the patients that had a radicular deficit recovered totally. Conclusions. Foraminal lumbar di sc herniation involves characteristic clinical features. Radiologic di agnosis requires high-resolution computed tomography, computed tomogra phic discography, or magnetic resonance imaging. Most foraminal lumbar disc herniations are reached through the interlaminar exposure extend ed to the upper lamina and medial facet without total facetectomy. An extra-articular approach should be reserved for extra-foraminal hernia tions.