Massive lumbar disc herniation treated with a transdural approach and posterior fusion. A case report

IF 0.4 Q4 CLINICAL NEUROLOGY Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Pub Date : 2023-11-20 DOI:10.1016/j.inat.2023.101924

Takashi Sono , Kenji Nakatani , Kazuaki Morizane , Kazushi Otsuka , Kazutaka Takatsuka

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Abstract

Background

Lumbar disc herniation (LDH) at the upper levels (L1–2 and L2–3) is different from that at the lower levels with regard to clinical characteristics and surgical outcomes. Discectomy using the transdural approach is a good option for central LDH at the upper levels; however, postoperative instability and recurrence are the major concerns.

Case presentation

A 57-year-old woman experienced severe back pain and dysuria. Magnetic resonance imaging (MRI) revealed a massive LDH at the L1–2 level. Despite conservative treatment for 3 months, her low back pain was not relieved. Posterior lumbar interbody fusion (PLIF) with bilateral facetectomy was performed, and the residual LDH was subsequently removed using the transdural approach. The patient’s preoperative symptoms were relieved after surgery.

Conclusions

PLIF followed by discectomy using the transdural approach is a safe and useful surgical method to treat a massive LDH at the upper levels.

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经硬膜入路后路融合术治疗大面积腰椎间盘突出症。病例报告

背景:高节段(L1-2和L2-3)的腰椎间盘突出症(LDH)在临床特征和手术结果方面与低节段的腰椎间盘突出症不同。经硬膜入路椎间盘切除术是上节段中枢性LDH的良好选择;然而，术后不稳定和复发是主要的问题。病例表现:一名57岁女性出现严重的背部疼痛和排尿困难。磁共振成像(MRI)显示在L1-2水平有大量LDH。保守治疗3个月后，腰痛仍未缓解。后路腰椎椎体间融合术(PLIF)联合双侧面部切除术，随后采用经硬膜入路去除残留LDH。手术后患者术前症状得到缓解。结论经硬膜入路椎体内固定联合椎间盘切除术是治疗上节段大量LDH的一种安全有效的手术方法。

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