Lumbar disc herniation (LDH)

Radiculopathy: pain and/or subjective sensory changes (numbness, tingling…) in the distribution of a nerve root dermatome, possibly accompanied by weakness and reflex changes of muscles innervated by that nerve root

● typical disc herniationradiculopathy in the nerve exiting at the level below

● massive disc herniations can → cauda equina syndrome (a medical emergency). Typical symptoms: saddle anesthesia, urinary retention, LE weakness.

● most patients do as well with conservative treatment as with surgery, ∴ initial nonsurgical (conservative) treatment should be attempted for the vast majority

● surgery indications: cauda equina syndrome, progressive symptoms or neurologic deficits despite conservative treatment, or severe radicular pain > ≈ 6 weeks

Lumbar disc herniation (LDH) occurs owing to the inability of the posterior longitudinal ligament (PLL) to preserve the disc material within the intervertebral space. There is apparently no study that has investigated the histopathological changes occurring in both PLL and disc material in patients with LDH.

Kilitci et al. investigated and compared the histopathological changes occurring in PLL and disc material of the patients who underwent a surgical operation for LDH.

Pathology and neurosurgery departments of a tertiary health care institution. The study included patients who underwent surgical operation for LDH from January 2018 to May 2019 and whose PLL and disc material was removed together, and had disc degeneration findings that were radiologically and histologically concordant.

PLL degeneration scores according to the histopathological findings, changes in disc materials according to the MRI findings, disc degeneration scores according to the histopathological findings.

Sample size: 50.

MRI and histological examinations showed fully degenerated black discs (Grade 2) in 12 patients, partially degenerated discs (Grade 1) in 29 patients, and fresh/acute discs (Grade 0) in 9 patients. The PLL showed grade 0 degeneration in 2 patients, grade 1 degeneration in 23 patients, and grade 2 degeneration in 25 patients. PLL degeneration grades were higher than the disc degeneration grades (P=.002).

Longitudinal ligament degeneration can play a significant role in the pathogenesis of LDH. This study represents the first to focus on the histopathological changes occurring in both the PLL and disc material in patients with LDH 1).



Smoking status

Pfirrmann grading system grade

Analgesic use

Leg pain duration

Kilitci A, Asan Z, Yuceer A, Aykanat O, Durna F. Comparison of the histopathological differences between the spinal material and posterior longitudinal ligament in patients with lumbar disc herniation: A focus on the etiopathogenesis. Ann Saudi Med. 2021 Mar-Apr;41(2):115-120. doi: 10.5144/0256-4947.2021.115. Epub 2021 Apr 1. PMID: 33818148.
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  • Last modified: 2023/03/06 16:34
  • by administrador