Abdullah A F, Wolber P G, Warfield J R, Gunadi I K
Department of Neurosurgery, Washington County Hospital, Hagerstown, Maryland.
Neurosurgery. 1988 Apr;22(4):648-53. doi: 10.1227/00006123-198804000-00005.
Extreme lateral disc herniations in the authors' series account for 10% of all lumbar herniations; 80% occurred at the L3, L4 and L4, L5 interspaces. The authors review the clinical findings in 138 patients and point to the characteristic features of the clinical syndrome. They compare the accuracy of various diagnostic studies and conclude that computed tomography is highly accurate and should be used before other diagnostic studies. Discography is still helpful as a confirmatory study in some cases, whereas myelography is particularly useful in disclosing other associated lesions. Analysis of the operative series revealed a high percentage of extruded fragments (60%) and a significant number of double herniations on the same side and at the same level (15%). These two findings may respectively preclude chemonucleolysis and microsurgery from the surgical management of extreme lateral herniations. Double herniations explain some discrepancies in the clinical picture and are emphasized as a potential source of error in diagnosis. The surgical technique allows exploration for herniations within the intervertebral canal as well as for extraforaminal herniations without sacrifice of the facet. Operative results are presented.
在作者的病例系列中，极外侧椎间盘突出症占所有腰椎间盘突出症的10%；80%发生在L3、L4和L4、L5椎间隙。作者回顾了138例患者的临床发现，并指出了该临床综合征的特征。他们比较了各种诊断研究的准确性，得出结论：计算机断层扫描高度准确，应在其他诊断研究之前使用。椎间盘造影在某些情况下作为一项确诊性检查仍然有用，而脊髓造影在发现其他相关病变方面特别有用。对手术病例系列的分析显示，脱出碎片的比例很高（60%），且在同一侧和同一水平存在大量双侧突出（15%）。这两个发现可能分别使化学溶核术和显微手术不适用于极外侧突出症的手术治疗。双侧突出解释了临床表现中的一些差异，并被强调为诊断中潜在的误差来源。该手术技术允许探查椎管内的突出以及椎间孔外的突出，而无需切除小关节。文中展示了手术结果。
