Laterality of lumbar disc herniation

Published:November 09, 2022DOI:



      Lumbar disc herniation (LDH) is most common in men aged 20–40 at the L4/5 level; however, left-right differences have not been reported. Improving our understanding of left- and right-side LDH may facilitate the estimation of mechanical load on intervertebral discs. Here, we assessed left-right differences in LDH via a retrospective analysis of LDH cases.


      Among 10,972 surgical cases of LDH identified in the Nagoya Spine Group database, 2899 in which right- and left-LDH sides were observable in a single vertebral segment were identified (mean age 46.3 ± 16.6 years, 2028 males). The following characteristics of patients with right- and left-LDH were compared: age, LDH level, surgical technique, operative time, blood loss, length of hospital stay, preoperative Japan Orthopaedic Association (JOA) score, and JOA recovery rate.


      LDH occurred on the right and left sides in 1358 and 1541 patients, respectively, with patients with right-side LDH significantly older than those with left (47.9 ± 16.6 versus 45.0 ± 16.5, respectively; p < 0.001). No between-group differences in sex, age, LDH level, surgical technique, operative time, blood loss, length of hospital stay, preoperative JOA score, or JOA recovery rate were observed. The occurrence of right-side LDH increased with age, occurring in 42.7%, 45.1%, 49.9%, and 54.7% of patients aged 10–29, 30–49, 50–69, and 70–89 years, respectively.


      Left-side LDH was observed more frequently than right; however, right-side LDH incidence increased with age. No significant between-group differences regarding symptoms, treatments, or outcomes were observed.


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        • Jordan J.
        • Konstantinou K.
        • O’Dowd J.
        Herniated lumbar disc.
        BMJ Clin Evid. 2009 Mar 26; 2009
        • Deyo R.A.
        • Tsui-Wu Y.J.
        Descriptive epidemiology of low-back pain and its related medical care in the United States.
        Spine (Phila Pa 1976). 1987 Apr; 12: 264-268
        • Fjeld O.R.
        • Grøvle L.
        • Helgeland J.
        • Småstuen M.C.
        • Solberg T.K.
        • Zwart J.A.
        • et al.
        Complications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation.
        Bone Joint Lett J. 2019 Apr; 101-b: 470-477
        • Amin R.M.
        • Andrade N.S.
        • Neuman B.J.
        Lumbar Disc Herniation. Curr Rev Musculoskelet Med. 2017 Dec; 10: 507-516
        • Dammers R.
        • Koehler P.J.
        Lumbar disc herniation: level increases with age.
        Surg Neurol. 2002 Sep-Oct; 58 (discussion 12-3): 209-212
        • Takahashi Y.
        • Yasuhara T.
        • Kumamoto S.
        • Yoneda K.
        • Tanoue T.
        • Nakahara M.
        • et al.
        Laterality of cervical disc herniation.
        Eur Spine J. 2013 Jan; 22: 178-182
        • Gracovetsky S.
        • Farfan H.
        The optimum spine.
        Spine. 1986 Jul-Aug; 11: 543-573
        • Gomez T.T.
        Symmetry of lumbar rotation and lateral flexion range of motion and isometric strength in subjects with and without low back pain.
        J Orthop Sports Phys Ther. 1994 Jan; 19: 42-48
        • Gao X.
        • Shen F.
        • Wang L.
        • Ma Y.
        • Niu H.
        • Fan Y.
        Two-dimensional dynamic walking stability of elderly females with a history of falls.
        Med Biol Eng Comput. 2021; 59: 1575-1583
        • Bauby C.E.
        • Kuo A.D.
        Active control of lateral balance in human walking.
        J Biomech. 2000 Nov; 33: 1433-1440
        • Spangfort E.V.
        The lumbar disc herniation: a computer-aided analysis of 2,504 operations.
        Acta Orthop Scand. 1972; 43: 1-99
        • Davis R.A.
        A long-term outcome analysis of 984 surgically treated herniated lumbar discs.
        J Neurosurg. 1994 Mar; 80: 415-421
        • Donceel P.
        • Du Bois M.
        Fitness for work after surgery for lumbar disc herniation: a retrospective study.
        Eur Spine J. 1998; 7: 29-35
        • Sadeghi H.
        • Allard P.
        • Prince F.
        • Labelle H.
        Symmetry and limb dominance in able-bodied gait: a review.
        Gait Posture. 2000; 12: 34-45
        • Singh I.
        Functional asymmetry in the lower limbs.
        Cells Tissues Organs. 1970; 77: 131-138
        • Du Chatinier K.
        • Rozendal R.H.
        Temporal symmetry of gait of selected normal human subjects.
        Proc Koninklijke Nederl Akademie Wetenschappen C. 1970; 73: 353-361
        • Law H.T.
        Microcomputer-based low-cost method for measurement of spatial and temporal parameters of gait.
        J Biomed Eng. 1987; 9: 115-120
        • Allard P.
        • Lachance R.
        • Aissaoui R.
        • Duhaime M.
        Simultaneous bilateral 3-D able-bodied gait.
        Hum Mov Sci. 1996; 15: 327-346
        • Chodera J.D.
        • Levell R.W.
        Footprint patterns during walking.
        in: Kenedi R.M. Perspectives in biomedical engineering: proceedings of a symposium organised in association with the biological engineering society and held in the university of strathclyde, Glasgow, 1972. Palgrave Macmillan UK, London1973: 81-90
        • Stefanyshyn D.J.
        • Engsberg J.R.
        Right to left differences in the ankle joint complex range of motion.
        Med Sci Sports Exerc. 1994 May; 26: 551-555
        • Gundersen L.A.
        • Valle D.R.
        • Barr A.E.
        • Danoff J.V.
        • Stanhope S.J.
        • Snyder-Mackler L.
        Bilateral analysis of the knee and ankle during gait: an examination of the relationship between lateral dominance and symmetry.
        Phys Ther. 1989 Aug; 69: 640-650
        • Hirasawa Y.
        An observation on standing ability of Japanese males and females.
        J Anthropol Soc Nippon. 1979; 87: 81-92
        • Matsusaka N.
        • Fujitta M.
        • Hamamina A.
        • Norimatsu T.
        • Suzuki R.
        Relationship between right and left leg in human gait from a viewpoint of balance control.
        Biomechanics IX-A. 1985; (;Champaign (3):427–30)
        • Hirokawa S.
        Normal gait characteristics under temporal and distance constraints.
        J Biomed Eng. 1989; 11: 449-456
        • Paul C.P.
        • de Graaf M.
        • Bisschop A.
        • Holewijn R.M.
        • van de Ven P.M.
        • van Royen B.J.
        • et al.
        Static axial overloading primes lumbar caprine intervertebral discs for posterior herniation.
        PLoS One. 2017; 12e0174278
        • Desmoulin G.T.
        • Pradhan V.
        • Milner T.E.
        Mechanical aspects of intervertebral disc injury and implications on biomechanics.
        Spine. 2020; 45
        • Ravichandran D.
        • Pillai J.
        • Krishnamurthy K.
        Genetics of intervertebral disc disease: a review.
        Clin Anat. 2022 Jan; 35: 116-120
        • Wu W.
        • Chen Y.
        • Yu L.
        • Li F.
        • Guo W.
        Coronal and sagittal spinal alignment in lumbar disc herniation with scoliosis and trunk shift.
        J Orthop Surg Res. 2019 Aug 20; 14: 264
        • Lorio M.P.
        • Bernstein A.J.
        • Simmons E.H.
        Sciatic spinal deformity-lumbosacral list: an “unusual” presentation with review of the literature.
        J Spinal Disord. 1995 Jun; 8: 201-205
        • Barker K.L.
        • Shamley D.R.
        • Jackson D.
        Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability.
        Spine. 2004; 29: E515-E519
        • Hides J.A.
        • Stokes M.J.
        • Saide M.
        • Jull G.A.
        • Cooper D.H.
        Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain.
        Spine. 1994; 19: 165-172