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This paper presents ten cases of lumbar spinal nerve root disorder differing from ordinary lumbar disc herniation (LDH) in pathology. The lumbar spinal nerve roots of the ten patients were entrapped or anchored to the posterior longitudinal ligament (PLL), as in entrapment peripheral neuropathy, causing symptoms of radiculopathy similar to LDH. Regression or complete resorption of LDH has been frequently reported. The pathology of perineural conditions after spontaneous resorption, however, has not been expensively studied. We compared disc degeneration in these patients with degeneration in patients with ordinary LDH, based on magnetic resonance imaging (MRI). We also compared the clinical courses in the two groups. The affected discs of 106 patients with low back pain and sciatica, treated operatively for LDH from July 1989 to October 1994 were studied and graded by MRI to assess disc degeneration. Of these 106 patients, 10 exhibited lumbar spinal nerve adhesion to the PLL (entrapment radiculopathy) without herniation mass on myelogram, computed tomography (CT)-myelogram, and MRI. The disc degeneration in the 10 patients showing nerve root entrapment corresponded to that in the 96 patients with LDH. All ten patients had a similar clinical history of recurrent sciatica and low back pain after remission of the first onset, and good results were obtained after neurolysis with free fat grafting, performed to protect against perineural scar formation or adhesions. One patient was follow-up from onset to recurrence by MRI. The pathology “entrapment radiculopathy” may be present in some patients with LDH after spontaneous resorption. Careful follow-up is necessary, even when spontaneous resorption of LDH is recognized by MRI or CT. |
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