Clinical Outcome after Surgical Treatment of the Central Disc Herniation / 대한척추외과학회지

ABSTRACT

STUDY DESIGN: This is a retrospective study OBJECTIVE: We wanted to to assess the clinical features of central disc herniation and the differences in the clinical outcome between discectomy and fusion. Summary of the literature REVIEW Central disc herniation appears to have poorer results than does posterolateral herniation in the literature. In most reports, persistent back pain was often found after discectomy and it may be related to the anatomical characteristics of the posterior longitudinal ligament in the lower lumbar region. MATERIALS AND METHOD: Central disc herniation was defined as a herniated mass that occupied more than 50% of the spinal canal and the maximal deviation of the apex was within 2 mm from the midline. 27 patients were operated on with using these criteria and they were subdivided by the operation methods. Laminotomy and discectomy was done in 20 patients. Posterior lumbar interbody fusions were performed on the other 7 patients with significant back pain. We compared the neurological improvement and the clinical outcomes. RESULTS: Preoperative back pain was significantly more frequent in the PLIF group. The other clinical features were significantly improved in the both groups, but the differences were not statistically significant. Satisfactory clinical outcomes were obtained in 70 percent of the discectomy group and in 100 percent of the PLIF group, respectively, but this was not significantly different. CONCLUSION: The presence of significant back pain was considered as an indication for performing fusion in our series. The clinical outcome of central disc herniation after PLIF was slightly better than that of discectomy in spite of the preoperative back pain in the PLIF group, but the difference was not statistically significant.