A new technique for the treatment of lumbar far lateral disc herniation: technical note and preliminary results

Eur Spine J. 2003 Jun;12(3):320-4. doi: 10.1007/s00586-002-0496-5. Epub 2002 Dec 11.

Abstract

A newly designed technique for a minimally invasive approach to the laterally herniated disc is presented. Fifteen patients suffering from far lateral disc herniation (extraforaminal) were operated according to this technique. Through a small skin incision (1.5 cm), the paraspinal muscles are spread by dilators, until a working channel of 9 mm inner diameter and 11 mm outer diameter can be placed. The next steps are done through this channel using the surgical microscope. No bone resections are necessary and the facet joints are left untouched. However, partial resection of the intertransverse ligament may be necessary. The mean follow-up period for these 15 patients was 11.5 months, and they were evaluated by using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The average surgical time was 43 min. The ODI improved from 30.6 (preoperative) to 14.3 (postoperative). The VAS of leg pain improved from 7 (preoperative) to 3.6 (postoperative), which represented a statistically significant improvement at the significance level of (P<0.01). No intra-operative or early postoperative complications occurred. However, one recurrence did occur, which was treated by the same technique. This technique combines the advantages of three-dimensional visual control (operating microscope) with the minimal surgical trauma of endoscopic techniques, while avoiding some of the shortcomings of both the microsurgical and endoscopic techniques.

MeSH terms

  • Adult
  • Aged
  • Back Pain / pathology
  • Back Pain / physiopathology
  • Back Pain / surgery
  • Female
  • Humans
  • Intervertebral Disc / diagnostic imaging
  • Intervertebral Disc / pathology
  • Intervertebral Disc / surgery*
  • Intervertebral Disc Displacement / diagnostic imaging
  • Intervertebral Disc Displacement / pathology
  • Intervertebral Disc Displacement / surgery*
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / pathology
  • Lumbar Vertebrae / surgery*
  • Male
  • Middle Aged
  • Muscle Weakness / pathology
  • Muscle Weakness / physiopathology
  • Muscle Weakness / surgery
  • Muscle, Skeletal / injuries
  • Muscle, Skeletal / surgery
  • Neurosurgical Procedures / instrumentation
  • Neurosurgical Procedures / methods*
  • Paresthesia / pathology
  • Paresthesia / physiopathology
  • Paresthesia / surgery
  • Postoperative Complications / prevention & control
  • Radiography
  • Spinal Nerve Roots / pathology
  • Spinal Nerve Roots / physiopathology
  • Spinal Nerve Roots / surgery
  • Zygapophyseal Joint / surgery