Lumbar Disc Herniations Causing Contralateral Radicular Symptoms: Can They Be Explained by a Hypotenusal Theory?

Lumbar Disc Herniations Causing Contralateral Radicular Symptoms: Can They Be Explained by a Hypotenusal Theory?

World Neurosurg. 2018 Apr 05;:

Authors: Asan Z

Abstract
OBJECTIVE: Cases presenting contralateral radicular symptoms are rarely encountered. It is difficult to decide on the correct side in cases where surgical intervention will be performed. The aim of the study is to explain the symptomatology in cases of Lumbar Disc Herniations causing contralateral radicular symptoms by a hypotenusal effect.
MATERIALS AND METHODS: In total, 27 cases were included in the study. 8 cases underwent surgical interventions performed on the side where disc herniation was radiologically detected. 19 cases were treated conservatively. Disc herniations were radiologically evaluated in 3 different groups, and the effect on the root on the symptomatic side was explained by a hypotenusal theory. Correlations between symptomatology, clinical findings, MRI, EMG were discussed.
RESULTS: Clinical improvement was observed in all cases that were operated on the side where disc herniation was detected radiologically. Neurological examination findings in the postoperative period also revealed the correctness of the selected surgical approach. EMG is insufficient to explain clinical findings and to decide on the surgical side.
CONCLUSION: Lumbar disc herniations, which lead to contralateral radicular symptoms, should be operated from the side where the disc was radiologically detected. Top of the disc is responsible for symptomatology. Surgical excision of the top of the disc removes the contralateral root traction and the root compression on the same side.

PMID: 29627631 [PubMed - as supplied by publisher]

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