Lumbar disc herniation with contralateral radiculopathy: a systematic review on pathophysiology and surgical strategies
| Autor: | Alisson Roberto Teles, Matheus Fernandes de Oliveira, Guilherme José Agnoletto, Afonso Henrique de Aragão, Joel Sanabria Duarte, Leonardo Gilmone Ruschel |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Nerve root Pain Intervertebral Disc Degeneration Neurosurgical Procedures 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Radiculitis medicine Humans Posterior longitudinal ligament Radiculopathy Lumbar Vertebrae business.industry General Medicine medicine.disease Pathophysiology Surgery Observational Studies as Topic Stenosis medicine.anatomical_structure Ligament Female Neurology (clinical) Neurosurgery Lumbar disc herniation business Intervertebral Disc Displacement 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgical Review. 44:1071-1081 |
| ISSN: | 1437-2320 0344-5607 |
| DOI: | 10.1007/s10143-020-01294-3 |
| Popis: | Lumbar disc herniation (LDH) is a relatively common pathology usually presenting with unilateral radiculopathy ipsilateral to the disc herniation. Some patients can present with contralateral radicular symptoms. The objective of this article is to review the current literature on lumbar disc herniations with contralateral radiculopathy regarding its pathophysiology and surgical strategies. A systematic review of the literature on LDH with contralateral radiculopathy was performed using MEDLINE (via PubMed) using MeSH terms. This review was done following recommendations of PRISMA statement and PICOT strategy of search. Initial electronic search identified 126 papers. Finally, 18 articles were reviewed. None of the included papers was described as comparative. Pathophysiological processes underlying contralateral pain may include prominent spondylotic changes and the accompanying stenosis; hypertrophic yellow ligament; dural attachments along the posterior longitudinal ligament; nerve root traction forces; and friction radiculitis, migrated epidural fat, nerve root anomaly, and venous congestion inside the vertebral canal. In our pooled analysis, 11 patients reported were treated by bilateral approach with 100% of clinical success and no complications. Eight patients were treated by unilateral approach ipsilateral to pain with 100% of clinical success and no complications. Forty-eight patients were treated by unilateral approach ipsilateral to herniation with 100% of clinical success and no complications. Pathophysiology underlying contralateral pain in LDH is probably multifactorial. There is not enough scientific evidence to define the best surgical approach for patients with LDH and contralateral pain. |
| Databáze: | OpenAIRE |
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