Microsurgery versus Medical Treatment for Neuropathic Pain Caused by Foraminal Extraforaminal Lumbar Disc Herniation: An Observational Study

Özet

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 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 LeedsAssessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale was ≥ 12 points. The NP scores were evaluated duringpatient 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 (19women, 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 patientsbefore medical treatment (43%). The most common neuropathic symptom for patients was a burning sensation. NP was found morecommon in patients who were of at advanced age (> 65 years) (p=0.019), had a longer clinical duration (p=0.007) or had a foraminaldisc herniation (p=0.038).CONCLUSION: Chronic compression of the dorsal root ganglion by FEFLDH is a significant cause of NP. If surgical treatment isdelayed for FEFLDH, the risk of persistent NP may increase.