Lumbar radiculopathy: Outcome analysis following treatment by only fixation - A report of an early experience of 44 cases

Abstract

Objective: An alternative novel form of surgical treatment for patients having prolapsed or bulging intervertebral disc, with or without associated osteophyte, related lumbar radiculopathy by "only fixation" or internal orthosis and aiming for segmental arthrodesis is presented.

Materials and methods: During the period July 2014-October 2018, 44 patients presenting with symptoms of lumbar radiculopathy and diagnosed to have bulging, prolapsed or herniated lumbar intervertebral disc with or without associated osteophytes were treated by only spinal stabilization without resorting to any kind of bone, ligaments, osteophyte, or disc resection.

Results: All patients had "immediate" postoperative relief from radicular symptoms. The Visual Analog Scale and the Oswestry Disability Index scores were used to assess the patient both before and after the surgical treatment. During the follow-up period that ranged from 10 to 60 months (average: 35 months), there was no recurrence of symptoms. Complete or significant resorption of the herniated disc was seen in 29 cases on follow-up radiological assessment.

Conclusions: Spinal segmental fixation without any manipulation of the herniated disc or osteophyte and without any kind of bone or soft-tissue decompression is a safe, effective, and rational method of treatment of lumbar radiculopathy related to intervertebral disc herniation.

Keywords: Lumbar intervertebral disc; osteophyte; radiculopathy; spinal instability.

Figure 1

Preoperative images of a 35-year-old male patient, (a) T2-weighted magnetic resonance imaging showing a large L5–S1 disc herniation. (b) Axial image of magnetic resonance imaging showing disc herniation. (c) Computed tomography scan of the lumbar spine

Figure 2

Postoperative images. (a) Postoperative computed tomography scan of the lumbar spine showing sectioning of the spinous processes. Bone graft pieces are seen in the midline. No other part of bone has been removed. (b) Postoperative computed tomography scan showing transarticular screws at L3–4, L4–5, and L5–S1 levels. (c) Postoperative magnetic resonance imaging (3 months after surgery) showing resorption of the herniated disc. (d) Axial magnetic resonance imaging image showing resorption of the herniated disc

Figure 3

Preoperative images of a 44-year-old female patient. (a) T2-weighted magnetic resonance imaging showing L5–S1 herniated disc. (b) Axial image of magnetic resonance imaging showing disc herniation. (c) Preoperative computed tomography scan

Figure 4

Postoperative images. (a) Postoperative computed tomography scan showing sectioning of the spinous processes. Bone graft pieces are seen placed in the midline. (b) Computed tomography scan showing double-insurance screw insertion at each articulation for three spinal levels. (c) Postoperative magnetic resonance imaging (6 months after surgery) shows almost complete resorption of the herniated disc. (d) Axial images of magnetic resonance imaging showing disc resorption