Turkish Neurosurgery 2019 , Vol 29 , Num 6
Microsurgery versus Medical Treatment for Neuropathic Pain Caused by Foraminal Extraforaminal Lumbar Disc Herniation: An Observational Study
Vaner KOKSAL1,Rahmi Kemal KOC2
1University of Health Sciences, Samsun Health Practices and Research Center, Department of Neurosurgery, Samsun, Turkey
2Erciyes University, School of Medicine, Department of Neurosurgery, Kayseri, Turkey
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 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 at 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. Keywords : Dorsal root ganglia, Lumbar disc herniation, Neuropathic pain, Surgical timing, Transmuscular intertransverse surgery

Corresponding author : Vaner KOKSAL, vanerkoksal@hotmail.com