Lee Dong Yeob, Lee Sang-Ho
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
J Korean Neurosurg Soc. 2008;44(1):19-25. doi: 10.3340/jkns.2008.44.1.19. Epub 2008 Jul 20.
To analyze the relationship of concomitant foraminal lumbar disc herniation (FLDH) with postoperative leg pain after microdecompression for extraforaminal lumbar disc herniation (EFLDH) at the L5-S1 level.
Sixty-five patients who underwent microdecompression for symptomatic EFLDH at the L5-S1 level were enrolled. According to the severity of accompanying FLDH, EFLDH was classified into four categories (Class I : no FLDH; Class II : mild to moderate FLDH confined within a lateral foraminal zone; Class III : severe FLDH extending to a medial foraminal zone; Class IV : Class III with intracanalicular disc herniation). The incidence of postoperative leg pain, dysesthesia, analgesic medication, epidural block, and requirement for revision surgery due to leg pain were evaluated and compared at three months after initial surgery.
The incidences of postoperative leg pain and dysesthesia were 36.9% and 26.1%, respectively. Pain medication and epidural block was performed on 40% and 41.5%, respectively. Revision surgery was recommended in six patients (9.2%) due to persistent leg pain. The incidences of leg pain, dysesthesia, and requirement for epidural block were higher in Class III/IV, compared with Class I/II. The incidence of requirement for analgesic medication was significantly higher in Class III/IV, compared with Class I/II (p=0.02, odds ratio=9.82). All patients who required revision surgery due to persistent leg pain were included in Class III/IV.
Concomitant FLDH seems related to postoperative residual leg pain after microdecompression for EFLDH at the L5-S1 level.
分析L5 - S1节段椎间孔外型腰椎间盘突出症（EFLDH）行显微减压术后，合并椎间孔内腰椎间盘突出症（FLDH）与术后腿痛的关系。
纳入65例行L5 - S1节段有症状的EFLDH显微减压术的患者。根据合并FLDH的严重程度，将EFLDH分为四类（I类：无FLDH；II类：轻度至中度FLDH局限于外侧椎间孔区；III类：严重FLDH延伸至内侧椎间孔区；IV类：III类合并椎管内椎间盘突出）。在初次手术后三个月，评估并比较术后腿痛、感觉异常、止痛药物使用、硬膜外阻滞以及因腿痛进行翻修手术的发生率。
术后腿痛和感觉异常的发生率分别为36.9%和26.1%。分别有40%和41.5%的患者使用了止痛药物和进行了硬膜外阻滞。因持续性腿痛，6例患者（9.2%）被建议行翻修手术。与I/II类相比，III/IV类患者的腿痛、感觉异常及硬膜外阻滞的发生率更高。与I/II类相比，III/IV类患者止痛药物使用的发生率显著更高（p = 0.02，比值比 = 9.82）。所有因持续性腿痛需要翻修手术的患者均属于III/IV类。
L5 - S1节段EFLDH行显微减压术后，合并FLDH似乎与术后残留腿痛有关。
