Contained and Noncontained Lumbar Disc Herniation in the Same Patient

Study Design. A case report containing description of symptoms, signs, and selected treatment in two patients with lumbar disc herniation where the type of herniation changed from contained to noncontained in less than 1 year. Objectives. To demonstrate the difference in clinical appearance related to the type of herniation. Summary of Background Data. The clinical appearance of lumbar disc herniation regarding onsets of symptoms, severity of pain, and clinical findings are related to the type of herniation, as is the treatment. Methods. Two case reports are presented with description of anamneses, clinical findings, neuroradiographic findings, and treatment. Results. Both patients suffered from a transient left-side sciatica due to a contained lumbar disc herniation, improved by physiotherapy. After several months, both patients had an instantaneous increase in contralateral leg pain, and the recurrent, intense pain was caused by a sequestration of the previous contained herniation. The neurologic findings were more severe, and the patients were operated on, with subsequent improvement. Conclusions. The case reports illustrate the difference in clinical appearance of disc herniation related to the type of herniation, with a more aggressive clinical appearance in conjunction with perforation of the posterior longitudinal ligament with extrusion of disc material.