Affiliation:
1. Department of Neurosurgery, Seoul National University College of Medicine; 3 Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea; 4 Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
Abstract
Background: Some patients with lumbar herniated intervertebral disc disease (HIVD) suffer
from both pain and lateral shift or trunk list. In addition to pain, patients have concerns
regarding whether trunk list is reversible. Surgical treatment is performed when pain is
intractable to conservative management, but a reversal of trunk list is an incidental outcome.
Percutaneous lumbar endoscopic discectomy (PELD) is one of the surgical treatment options
for lumbar HIVD, but no results concerning its effect on trunk list have been reported.
Objectives: The objectives of the present study were to determine the incidence of, and
risk factors for, trunk list scoliosis or lateral shift and to report the outcomes of trunk list after
PELD.
Study Design: Retrospective case study. IRB No. H 1111-025-384
Setting; University medical Center, Seoul, Korea.
Methods: We selected 164 patients who were less than 60 years old, complained of
unilateral leg pain, and underwent PELD. We measured the maximum trunk shift from the
central sacral vertical line (CSVL-max) on preoperative whole spine radiographs and classified
trunk list as CSVL-max ≥ 10 mm. CSVL-max was measured on serial radiographs taken at one,
3, 6, and 12 months postoperatively in patients with trunk list.
Results: Twenty-nine patients (17.9%) had trunk list (M:F=10:19; mean age, 37.1 ± 11.24
years). Female gender (OR 4.28; 95% CI, 1.49 – 12.3) and HIVD at L4-5 (OR 5.6; 95% CI,
1.8 - 16.7) were risk factors for trunk list. Trunk list was normalized (CSVL-max < 10 mm)
in 15 (52%) patients after PELD, and the median time for normalization was 3 – 6 months.
Prognostic factors for the recovery of trunk list were not identified.
Limitations: Selection bias should be considered in interpreting these results.
Conclusion: Trunk list, scoliosis or lateral shift, was observed in 18% of the patients at the
time of surgery. Female gender and L4-5 disc herniation were risk factors for trunk list. Trunk
list was reversible in more than 50% of patients within 6 months of PELD.
Key words: Lumbar, scoliosis, lumbar/sciatic, trunk list, endoscope, disc, discectomy, sciatica,
spine, percutaneous endoscopic discectomy
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine