Far Lateral Extraforaminal Disc Herniation after Percutaneous Laser Lumbar Discectomy

The authors report a case of far lateral disc herniation at L4-5 found one year after percutaneous laser lumbar discectomy. The patient was found to be suffering from new-onset right lumbar radiculopathy 6 months after his first operation, and post operative lumbar MRI confirmed a far lateral extraforaminal disc herniation at L4-5, with compression of the nerve. This corresponded to the nucleotomy site of the probe. The patient underwent surgery employng the combined paraspinal intertransverse and interlaminar approach, and his symptoms were relieved. This case emphasizes the importance of removing nuclear material, and shows that remaining material can herniate through a percutaneous discectomy window.

Secondary Lumbar Spinal Stenosis; Clinical and Radiological Features, and Surgical Outcomes (Five-years Follow Up)

One hunderd and ten patients who had undergone surgery for lumbar spinal stenosis between March, 1988 and March, 1991 were evaluated in terms of radiological findings, classification, clinical features, coexisting disease and postoperative results. The overall mean age was 60 years, and patients with lateral stenosis were, an average, 11years younger than those with central canal stenosis. There was a high incidence of coexisting disease but its effect on symptoms and disease progression was statistically not significant. Characteristic radiological features were disc height decrease, facet joint hypertrophy, facet joint arthrosis, diffuse bulging disc, and ligamentum flavum hypertrophy, but no significant difference between the sexes was seen Nor were there differences between the symptoms of patients with lateral and central stenosis, though claudication was found mainly in patients with multiple level stenosis. The relief of symptoms by decompressive surgery more significantly successful in lateral than in central stenosis, and the surgical success rate was 74%.