Turkish Neurosurgery
Microsurgery Versus Medical Treatment for Neuropathic Pain Caused by Foraminal or Extraforaminal Lumbar Disc Herniation: An Observational Study
Vaner Köksal1, Rahmi Kemal Koç 2
1University of Health Sciences-Samsun Health Practices and Research Center, Neurosurgery, Samsun,
2Erciyes University, Medical Faculty, Neurosurgery, Kayseri,
DOI: 10.5137/1019-5149.JTN.26988-19.1
Aim:To investigate the incidence of neuropathic pain (NP) in patients with foraminal/extraforaminal lumbar disc herniation (FEFLDH), the prognosis of NP and the effect of microsurgery on patients their treatment. Material and Methods:Two patient groups with FEFLDH were investigated: the surgery group underwent surgical treatment, and the medical-treated group received medical treatment. Patients were diagnosed with NP when the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale was ≥ 12 points. The NP scores were evaluated during patient admission and at 1, 6 and 12 months postoperation or during medical treatment. Results:The surgery group included 37 patients (18 women, 19 men); FEFLDHs were localised at the L3–4 (n = 9), L4–5 (n = 23) and L5–S1 (n = 5) levels. NP was detected in 16 patients before surgery (43%). The medical-treated group included 46 patients (19 women, 27 men); FEFLDHs were localised at the L2–3 (n = 7), L3–4 (n = 12) and L4–5 (n = 27) levels. NP was detected in 20 patients before medical treatment (43%). The most common neuropathic symptom for patients was a burning sensation. NP was found more common in patients who were of advanced age (> 65 years) (p = 0.019), had a longer clinical duration (p = 0.007) or had a foraminal disc herniation (p = 0.038).Conclusion:Chronic compression of the dorsal root ganglion by FEFLDH is a significant cause of NP. If surgical treatment is delayed for FEFLDH, the risk of persistent NP may increase.
Corresponding author : Vaner Köksal