Lumbar Disc Herniation Associated with Contralateral Neurological Deficit: Can Venous Congestion Be the Cause?
A 74 year-old female patient was admitted to our outpatient clinic because of low back and left leg pain. She was suffering from LDH for approximately 4 years. Her complaints recurred during the last two weeks before admission to the outpatient clinic. Conservative treatment measures including physical therapy failed and she was consulted for surgery. Neurological examination revealed foot drop (2/5) on the right side and a positive straight leg rising test at 30 degrees on the left side. Magnetic resonance imaging (MRI) demonstrated L4-5 left paramedian discal herniation (). Neurological deficit of the patient was on the right side in contrast to a left sided herniation. Surgery was offered and the patient accepted the operation. At the operation, left sided hemilaminectomy, extruded fragment removal and discectomy were initially performed. Because of the right sided neurological deficit, exploration of the right side had been decided and at the operation it was seen that there was prominent venous engorgement and congestion in the epidural space and the right L5 nerve root was seen as it embedded. Venous structures were cauterized with bipolar forceps. No discal protrusion was detected on the right side. Following the surgery the patient's pain was resolved but some remained on the lower back due to incision and surgery. The right sided neurological deficit improved to 4/5 in a few days. The patient was discharged after an uneventful postoperative period. The patient was completely free of pain and neurological deficit at the first year follow-up.