Abstract
The results of the microsurgical treatment of 300 patients with painful lumbar spinal diseases were reported. Radical removal of the disc material, preservation of the epidural fat tissue around the lumbar nerve roots, and meticulous hemostasis produced good results. Yet, even with this technique, a pseudoradicular or referred pain still developed after surgery, despite of the disappearance of a radicular pain or radicular signs.
Pseudoradicular pain is characterized by: 1) Lasegue sign only after raising the straightened leg more than 40 degrees; 2) no radicular signs; 3) marked pains localized in the area innervated by the dorsal ramus which is involved in a pathological process; and 4) no pain in the popliteal fossa.10) Our operative results revealed that this uncomfortable pain developed most frequently after operative procedures involving facets and lateral recesses, such as in facetectomy or foraminotomy for superior facet syndrome (80% postoperatively) and for cases of lumbar herniated disc (63% postoperatively). The pain could be elicited by stimulation or irritation of the dorsal rami of the lumbar spinal nerves during surgery involving the articular facets. That was why pseudoradicular pain frequently developed after treatment of superior facet syndrome based on hypertrophied articular process or lumbar herniated discs.
