Santini A, Pitto R P
Divisione di Ortopedia e Traumatologia, Ospedale Civile, Arezzo.
Ital J Orthop Traumatol. 1991 Sep;17(3):359-69.
Disk herniation lateral to the intervertebral foramen is defined as extraforaminal. Its particular anatomical site makes its clinical and neurologic features completely different from those of posteromedial and posterolateral disk herniations. Prior to the advent of computerized tomography, only diskography was capable of preoperatively identifying this rare disease. We present 5 cases of extraforaminal disk herniation, the clinical and tomographic diagnosis of which was confirmed at surgery. All patients had severe motor deficit and reported sciatica as prevalent over low back pain. The herniated disk was L4-5 in 2 cases and L5-S1 in 3 cases. The CT scan suggested disk protrusion in 2 cases, extrusion in 2 cases, and sequestration in 1 case. Four of these findings were confirmed intraoperatively. Diskectomy was done after hemilaminectomy and partial or total facetectomy. The clinical result was excellent in 2 cases and good in 3 cases after an average follow-up of 10 months. The use of CT scan as part of the routine diagnostic procedure in patients with radicular pain has lowered the number of cases which the surgical findings were inexplicably negative for disk herniation without having to resort to more complex and invasive diagnostic techniques such as myelo-CT and disk-CT. Moreover, preliminary tomographic localization of the extraforaminal disk herniation makes it possible to operate on the affected level using more conservative techniques. In any case, thorough clinical examination is essential for both correct interpretation of the CT scan and appropriate choice of treatment.
椎间孔外侧椎间盘突出被定义为椎间孔外突出。其特殊的解剖位置使其临床和神经学特征与后内侧和后外侧椎间盘突出完全不同。在计算机断层扫描出现之前，只有椎间盘造影术能够在术前识别这种罕见疾病。我们报告5例椎间孔外椎间盘突出病例，其临床和断层扫描诊断在手术中得到证实。所有患者均有严重的运动功能障碍，且坐骨神经痛比腰痛更为普遍。2例突出椎间盘位于L4-5，3例位于L5-S1。CT扫描显示2例为椎间盘膨出，2例为椎间盘脱出，1例为椎间盘游离。其中4项结果在手术中得到证实。在半椎板切除术和部分或全椎弓根切除术后进行椎间盘切除术。平均随访10个月后，2例临床结果优秀，3例良好。将CT扫描作为神经根性疼痛患者常规诊断程序的一部分，减少了手术发现椎间盘突出但原因不明为阴性的病例数量，而无需采用更复杂和侵入性的诊断技术，如脊髓CT和椎间盘CT。此外，椎间孔外椎间盘突出的初步断层定位使得可以使用更保守的技术在受影响的节段进行手术。无论如何，全面的临床检查对于正确解读CT扫描和适当选择治疗方法都至关重要。
