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Lumbar disc herniation with contralateral radiculopathy: a systematic review on pathophysiology and surgical strategies

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Abstract

Lumbar disc herniation (LDH) is a relatively common pathology usually presenting with unilateral radiculopathy ipsilateral to the disc herniation. Some patients can present with contralateral radicular symptoms. The objective of this article is to review the current literature on lumbar disc herniations with contralateral radiculopathy regarding its pathophysiology and surgical strategies. A systematic review of the literature on LDH with contralateral radiculopathy was performed using MEDLINE (via PubMed) using MeSH terms. This review was done following recommendations of PRISMA statement and PICOT strategy of search. Initial electronic search identified 126 papers. Finally, 18 articles were reviewed. None of the included papers was described as comparative. Pathophysiological processes underlying contralateral pain may include prominent spondylotic changes and the accompanying stenosis; hypertrophic yellow ligament; dural attachments along the posterior longitudinal ligament; nerve root traction forces; and friction radiculitis, migrated epidural fat, nerve root anomaly, and venous congestion inside the vertebral canal. In our pooled analysis, 11 patients reported were treated by bilateral approach with 100% of clinical success and no complications. Eight patients were treated by unilateral approach ipsilateral to pain with 100% of clinical success and no complications. Forty-eight patients were treated by unilateral approach ipsilateral to herniation with 100% of clinical success and no complications. Pathophysiology underlying contralateral pain in LDH is probably multifactorial. There is not enough scientific evidence to define the best surgical approach for patients with LDH and contralateral pain.

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Authors and Affiliations

  1. DFV Neuro, São Paulo, Brazil

    Leonardo Gilmone Ruschel & Matheus Fernandes de Oliveira

  2. Hospital Alemão Oswaldo Cruz, São Paulo, Brazil

    Leonardo Gilmone Ruschel & Matheus Fernandes de Oliveira

  3. Neurosurgery Department, Neurological Institute of Curitiba (INC), Curitiba, Paraná, Brazil

    Leonardo Gilmone Ruschel, Afonso Aragão & Joel Sanabria Duarte

  4. Neurosurgery Department, University of Utah, Salt Lake City, UT, USA

    Guilherme José Agnoletto

  5. Neurosurgery Department, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil

    Matheus Fernandes de Oliveira

  6. McGill Scoliosis and Spine Group, McGill University, Montreal, QC, Canada

    Alisson R. Teles

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  1. Leonardo Gilmone Ruschel
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  2. Guilherme José Agnoletto
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  3. Afonso Aragão
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Correspondence to Matheus Fernandes de Oliveira.

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Ruschel, L.G., Agnoletto, G.J., Aragão, A. et al. Lumbar disc herniation with contralateral radiculopathy: a systematic review on pathophysiology and surgical strategies. Neurosurg Rev 44, 1071–1081 (2021). https://doi.org/10.1007/s10143-020-01294-3

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  • DOI: https://doi.org/10.1007/s10143-020-01294-3

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