Hattori Satoshi, Maeda Toru
1Hachioji Spine Clinic, Hachioji, Tokyo, Japan; and.
2Department of Orthopedic Surgery, Anan Medical Center, Anan, Tokushima, Japan.
J Neurosurg Case Lessons. 2023 May 29;5(22). doi: 10.3171/CASE23198.
Contralateral lower limb radiculopathy is a potential early complication of oblique lumbar interbody fusion (OLIF) in degenerative lumbar disorders. Among several pathologies related to contralateral radiculopathy following OLIF, extraforaminal disc herniation during the OLIF procedure is very rare.
Case 1 is a 68-year-old male underwent L4-5 and L5-6 OLIF for recurrent lumbar canal stenosis-expressed right leg pain and muscle weakness after surgery. Case 2 is a 76-year-old female on whom L4-5 OLIF was performed for L4 degenerative spondylolisthesis and who presented right leg pain and numbness postoperatively. In both patients, OLIF cages were inserted into the posterior part of the disc space or obliquely and the extraforaminal extruded disc compressed opposite exiting nerve roots (L5 root in case 1 and L4 root in case 2) as shown on magnetic resonance imaging (MRI). Surgical decompression with discectomy was required for pain relief and neurological improvement in both cases.
When emerging from new-onset opposite limb radiculopathy attributed to the OLIF procedure, extraforaminal disc herniation should be considered a potential pathology and MRI is useful for early diagnosis and selecting a subsequent management, including surgery.
对侧下肢神经根病是退行性腰椎疾病行斜外侧腰椎椎间融合术（OLIF）潜在的早期并发症。在OLIF术后与对侧神经根病相关的几种病变中，OLIF手术过程中椎间孔外椎间盘突出非常罕见。
病例1为一名68岁男性，因复发性腰椎管狭窄接受L4-5和L5-6 OLIF手术，术后出现右腿疼痛和肌肉无力。病例2为一名76岁女性，因L4退行性椎体滑脱接受L4-5 OLIF手术，术后出现右腿疼痛和麻木。在这两名患者中，OLIF椎间融合器均斜向插入椎间盘间隙后部，如磁共振成像（MRI）所示，椎间孔外突出的椎间盘压迫对侧出口神经根（病例1为L5神经根，病例2为L4神经根）。为缓解疼痛和改善神经功能，两例患者均需行椎间盘切除术进行手术减压。
当OLIF术后出现新发对侧肢体神经根病时，应考虑椎间孔外椎间盘突出这一潜在病变，MRI有助于早期诊断并选择后续治疗方案，包括手术治疗。
