Posterior Endoscopic Surgery for Lumbar Disc Herniation with Contralateral Symptoms - A Report of Two Cases

Abstract

We report two cases of lumbar disc herniation with contralateral nerve root involvement, surgically treated with a microendoscopic disectomy system (METRx™-MED system). The nerve root of the symptomatic side (contralateral to the side of the disc herniation) had been compressed to the superior facet by herniated disc from the opposite side. Endoscopic observation revealed inflammatory findings of the nerve root on the symptomatic side, such as fibrosis, adhesion, redness and swelling. In contrast, on the non-symptomatic side (ipsilateral side of the disc herniation), the nerve root had been merely compressed by the herniated disc but did not demonstrate any inflammatory findings. Excision of the herniated disc and decompression of the non-symptomatic nerve root should be done first, approaching from the disc herniation side. After that, through the same approach, the nerve root of the opposite (symptomatic) side should be decompressed.

Minimally invasive surgery - posterior endoscopic surgery - lumbar disc herniation - contralateral symptoms

References

• 1 Choudhury AR, Taylor JC, Worthington BS, Whitaker R. Lumbar radiculopathy contralateral to upper disc herniation: report of 3 cases.  Br J Surg. 1978;  65 842-844
• 2 Auld AW, Dewall JG. Myelographic defect on the side opposite the leg pain.  Spine. 1979;  4 174-175
• 3 Foley KT, Smith MM. Microendoscopic discectomy.  Tech Neurosurg. 1997;  301-307
• 4 Yoshida M, Maio K, Sumiya H, Kawai M, Yamada H, Nakagawa Y. Indications and clinical outcome of posterior endoscopic surgery for lumbar and cervical radiculopathy.  Rinsho Seikei Geka. 2004;  39 563-569 , (in Japanese)
• 5 Yoshida M, Nakagawa Y, Maio K, Kawakami M, Ando M, Hashizume H, Minamide A. Indications and clinical outcomes of microendoscopic discectomy for lumbar disc herniation.  Rinsho Seikei Geka. 2005;  40 371-377 , (in Japanese)
• 6 Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis.  Neurosurgery. 2002;  51 ((Suppl 2)) 146-154
• 7 Guiot BH, Khoo LT, Fessler RG. A minimally invasive technique for decompression of the lumbar spine.  Spine. 2002;  27 432-438
• 8 Yoshida M, Ueyoshi A, Maio K, Kawai M, Nakagawa Y. Surgical procedures and clinical results of endoscopic decompression for lumbar canal stenosis. In: Dezawa A, Chen PQ, Chung JY (eds) State of the Art for Minimally Invasive Spine Surgery. Springer-Verlag, Tokyo 2005: 15-24
• 9 Sairyo K, Katoh S, Sakamaki T, Komatsubara S, Yasui N. A new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis.  J Neurosurg (Spine 3). 2003;  98 290-293
• 10 Ikuta K, Arima J, Tanaka T, Oga M, Nakano S, Sasaki K, Goshi K, Yo M, Fukagawa S. Short-term results of microendoscopic posterior decompression for lumbar spinal stenosis.  J Neurosurg (Spine 2). 2005;  624-633
• 11 Adamson TE. Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy; results of a new technique in 100 cases.  J Neurosurg (Spine 1). 2001;  95 51-57
• 12 Adamson TE. The impact of minimally invasive cervical spine surgery.  J Neurosurg (Spine 1). 2004;  1 43-46
• 13 Yabuki S, Kikuchi S. Endoscopic partial laminectomy for cervical myelopathy.  J Neurosurg (Spine 2). 2005;  98 170-174
• 14 Young S, Veerapen R, O'Laoire SA. Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report.  Neurosurgery. 1988;  23 628-632

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