Skip to main content
SpringerLink
Log in

Are there typical localisations of lumbar disc herniations? A prospective study

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

A prospective intra-operative analysis of the location of lumbar disc herniation was performed in 131 patients with verified 54% contained (incomplete) and 46% non-contained (complete) lumbar disc herniations. Bulging discs or protrusions are not included in this study.

Complete disc herniations occurred more frequently in the upper lumbar spine. The localization of the lumbar disc herniations within its segment showed no correlation to the affected level. 64% of the disc herniations were located medio-laterally, 20% laterally, 12% within or lateral of the intervertebral compartment and 5% in the midline. Nearly one third of all herniations were found at the level of the disc space. Medio-lateral disc herniations were displaced more often in a caudal direction, lateral herniations were found displaced upwards and downwards with similar frequency while extraforaminal herniations migrated significantly more often in a cranial direction.

The pathomechanism and anatomical pathways of disc fragment migration are discussed on the basis of a new concept of the anterior extradural space.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abdullah AF, Wolber GH, Waefield JR, Krist Gunadi I (1988) Surgical management of extreme lateral lumbar disc herniations: Review of 138 cases. Neurosurgery 22: 648–653

    PubMed  Google Scholar 

  2. Caspar W (1977) A new surgical approach for lumbar disc herniation causing less tissue damage through a microsurgical approach. Advances in neurosurgery, Vol 4. Springer, Berlin Heidelberg New York, pp 74–77

    Google Scholar 

  3. Chafetz NI, Genant HK, Moon KL (1983) Recognition of lumbar disc herniation with NMR. AJR 141: 1153–1156

    PubMed  Google Scholar 

  4. Dickmann C, Mamourian A, Drayer BP, Sonntag VKH, Spetzler RF (1990) MRimaging of lateral disc herniation. J Neurosurg 73: 642–643

    Google Scholar 

  5. Dillon WP, Kaseff LG, Knachstedt VE, Osborn AG (1983) Computed tomography and differential diagnosis of the extruded disc. J Comput Tomogr 7: 969–975

    Google Scholar 

  6. Duus P, Kahlau G (1950) Welche pathogenetische Bedeutung hat der Bandscheibenvorfall im Bereich der Lendenwirbelsäule? Bruns Beitr Klin Chir 180: 1–26

    Google Scholar 

  7. Ebeling U, Kalbarcyk H, Reulen HJ (1989) Microsurgical reoperations following lumbar disc surgery: time course, surgical findings and outcome in 92 patients. J Neurosurg 70: 397–404

    PubMed  Google Scholar 

  8. Ebeling U, Reulen HJ (1988) Mikrochirurgische Technik bei lumbalen Bandscheibenoperationen: ist die der konventionellen Methode überlegen? In: Walter W, Krenkel W (eds) Jahrbuch der Neurochirurgie 1988. Regensberg und Biermann, pp 143–160

  9. Edelmann R, Shoukimas GM, Stark DD (1985) High-resolution surface-coil imaging of lumbar disc disease. AJNR 6: 479–485

    Google Scholar 

  10. Fankhauser H, De Tribolet N (1987) Extreme lateral lumbar disc herniation. Br J Neurosurg 1: 111–129

    PubMed  Google Scholar 

  11. Farfan HF (1979) Biomechanik der Lendenwirbelsäule. In: Junghanns W (ed) Die Wirbelsäule in Forschung und Praxis, Bd. 80. Hippokrates Verlag, Stuttgart

    Google Scholar 

  12. Fick R (1904) Posterior longitudinal ligament. In: Fick R (ed) Handbuch der Anatomie und Mechanik der Gelenke, Vol 2. Jena, G Fischer, pp 80–82

    Google Scholar 

  13. Godersky IC, Erickson DL, Selijeskog EL (1984) Extreme lateral disc herniation: diagnosis by computed tomography. Neurosurgery 14: 549–552

    PubMed  Google Scholar 

  14. Huber P, Reulen HJ (1989) CT-Observations of the intra- and extracanalicular disc herniation. Acta Neurochir (Wien) 100: 3–11

    Google Scholar 

  15. Jane A, Haworth CS, Broaddus Lee JH, Malik J (1990) A neurosurgical approach to far lateral disc herniation. J Neurosurg 72: 143–144

    PubMed  Google Scholar 

  16. Kornberg M (1987) Extreme lateral lumbar disc herniations. Clinical syndrome and computed tomography recognition. Spine 12: 586–589

    PubMed  Google Scholar 

  17. Krämer J (1978) Bandscheibenbedingte Erkrankungen. Thieme, Stuttgart

    Google Scholar 

  18. Loew F, Caspar W (1978) Surgical approach to lumbar disc herniation. Advances and technical standards in neurosurgery, Vol 5. Springer, Wien New York, pp 153–174

    Google Scholar 

  19. Maroon JC, Abla AA (1985) Microlumbar discectomy. Clin Neurosurg 33: 407–417

    Google Scholar 

  20. Maroon JC, Kopitnik TA, Schulhof LA, Abla A, Wilberger JE (1990) Diagnosis and microsurgical approach to far lateral disc herniation. J Neurosurg 72: 378–382

    PubMed  Google Scholar 

  21. Masaryk TJ, Ross JS, Modic MT, Boumphrey F, Bohlman H, Wilbert G (1988) High-resolution imgaging of sequestered lumbar intervertebral discs. AJNR 9: 351–358

    Google Scholar 

  22. McCullough JA (1984) Chemonucleolysis: State of the art. In: Genant HK (ed) Spine update 1984. Radiology Research and Education Foundation, San Francisco, pp 127–139

    Google Scholar 

  23. Modic MT (1987) MRI of the Spine: clinical considerations. In: Genant HK (ed) Spine update 1987. Radiology Research and Education Foundation, San Francisco, pp 161–176

    Google Scholar 

  24. Novetsky GJ, Berlin L, Epstein AJ, Lono N, Miller SH (1982) The extraforaminal herniated disc: detection by computed tomography. AJNR 3: 653–655

    PubMed  Google Scholar 

  25. Osborn AG, Hood RS, Sherry RG (1988) CT/MR spectrum of far lateral and anterior lumbosacral disc herniations. AJNR 9: 755–778

    Google Scholar 

  26. Pfaundler S, Ebeling U, Reulen HJ (1989) Pedicle origin and intervertebral compartiment in the lumbar spine and upper sacral spine. A biometric study. Acta Neurochir (Wien) 97: 158–167

    Google Scholar 

  27. Prestar FJ, Putz R (1982) Das Ligamentum longitudinale posterior — Morphologie und Funktion. Morphol Med 2: 181–189

    Google Scholar 

  28. Putz R (1983) Zur Morphologie und Dynamik der Wirbelsäule. Radiologie 23: 145–150

    Google Scholar 

  29. Reulen HJ, Pfaundler S, Ebeling U (1987) The lateral microsurgical approach to the “Extracanalicular” lumbar disc herniation. Acta Neurochir (Wien) 84: 64–67

    Google Scholar 

  30. Saegesser M (1972) Spezielle chirurgische Therapie, 8th Ed. Huber, Berlin Stuttgart Wien

    Google Scholar 

  31. Schellinger D, Manz HJ, Vidic B, Patronas NJ, Deveikis JP, Muraki AS, Abdullah DC (1990) Disc fragment migration. Radiology 175(3): 831–836

    PubMed  Google Scholar 

  32. Schmorl G, Junghanns H (1959) The ligaments. In: Wild SP, Goin LS (eds) The human spine in health and disease, Am Ed. Grune and Stratton, New York, pp 16–17

    Google Scholar 

  33. Shannon N, Paul A (1979) L4/5 and L5/S1 disc protrusions: analysis of 323 cases operated on over 12 years. J Neurol Neurosurg Psychiatry 42: 804–809

    PubMed  Google Scholar 

  34. Siebner HR, Faulhauer K (1990) Frequency and specific surgical management of far lateral lumbar disc herniations. Acta Neurochir (Wien) 105: 124–131

    Google Scholar 

  35. Spangfort E (1972) The lumbar disc herniation. A computeraided analysis of 2504 operations. Acta Orthop Scand [Suppl] 142: 40–53

    Google Scholar 

  36. Thomalske G, Galow W, Ploke G (1979) Critical comments on a comparison of two series (1000 patients each) of lumbar disc surgery. In: Klinger M, Brock M (eds) Advances in neurosurgery, Vol 7. Springer, Blerin Heidelberg New York, pp 22–27

    Google Scholar 

  37. Volle E, Kern A, Stoltenberg G, Claussen C (1988) CT-Reconstruction technique in lumbar intraneuroforaminal disc. Neuroradiology 30: 136–144

    Google Scholar 

  38. Williams AL, Haughton VM, Daniels DL (1982) CT recognition of lateral lumbar disc herniation. AJNR 3: 211–213

    Google Scholar 

  39. Zucker L, Amacher AL, Eltomey A (1987) Juvenile lumbar discs. Childs Nerv Syst 3: 125–127

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurosurgical Clinic, University of Berne, Switzerland

    U. Ebeling

  2. Neurosurgical Clinic, University of Munich, Grosshadern, Federal Republic of Germany

    H. J. Reulen

Authors
  1. U. Ebeling
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. J. Reulen
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Dedicated to Prof. Peter Huber, our respected neuroradiologist and friend.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ebeling, U., Reulen, H.J. Are there typical localisations of lumbar disc herniations? A prospective study. Acta neurochir 117, 143–148 (1992). https://doi.org/10.1007/BF01400611

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01400611

Keywords

Search

Navigation