Transpars Microscopic Approach for the Treatment of Purely Foraminal Herniated Lumbar Disc

Bonis, Pasquale De; Mongardi, Lorenzo; Pompucci, Angelo; Ricciardi, Luca; Cavallo, Michele Alessandro; Farneti, Marco; Lapparelli, Marcello; Capone, Gennaro; Altruda, C; Schivalocchi, Roberta; Campioni, Paolo; Ghisellini, Giulia; Trapella, Giorgio

doi:10.1097/brs.0000000000001839

Cited by 8 publications

(2 citation statements)

References 21 publications

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“…Recently, percutaneous translaminar endoscopic approach was described for down-migrated LDH under local anesthesia without any dural or neural injuries. 23 For the treatment of purely foraminal LDH, De Bonis et al 24 reported on 47 patients using trans-pars microscopic approach with drilling the lateral border of the pars interarticularis. There were no cases of spinal instability and no recurrence at the follow-up.…”

Section: Discussionmentioning

confidence: 99%

Trans-Tubular Translaminar Microscopic-Assisted Nucleotomy for Lumbar Disc Herniations in the Hidden Zone

Abdelrahman

Seyed-Emadaldin

Krajnovic

et al. 2021

Global Spine Journal

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Study Design: A prospective cohort study in a high-flow spine center in Germany. Objectives: This study aimed to evaluate clinical outcomes and complications of the trans-tubular translaminar microscopic-assisted percutaneous nucleotomy in cases of cranially migrated lumbar disc herniations (LDH). Methods: Between January 2013 and January 2018, 66 consecutive patients with cranio-laterally migrated LDH were operated upon. The following outcome measures were evaluated: (1) Visual Analog Scale (VAS) for leg and back pain; (2) Oswestry Disability Index (ODI) and Macnab´s criteria. All patients were operated upon with trans-tubular Translaminar Microscopic-assisted Percutaneous Nucleotomy (TL-MAPN). Perioperative radiographic and clinical evaluations were reported. The mean follow-up period was 32 months. Results: The mean age was 59 years. L4/L5 was the commonest affected level (27 patients). The mean preoperative VAS for leg pain was 6.44 (±2.06), improved to 0,35 (±0.59) postoperatively. Dural injury occurred in 1 patient, treated with dural patch. Improved neurological function was reported in 41/44 Patients (neurological improvement rate of 93%) at the final follow up. There was a significant improvement in the mean ODI values, from 50.19 ± 4.92 preoperatively to 10.14 ± 2.22 postoperatively (P < 0.001). Sixty four out of 66 patients (96%) showed an excellent or good functional outcome according to Macnab´s criteria. No recurrent herniations were observed. Conclusion: The translaminar approach is a viable minimal invasive technique for cranially migrated LDH. The preservation of the flavum ligament is one of the main advantages of this technique. It is an effective, safe and reproducible minimally invasive surgical alternative in treatment of cranially migrated LDHs.

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Section: Discussionmentioning

confidence: 99%

Trans-Tubular Translaminar Microscopic-Assisted Nucleotomy for Lumbar Disc Herniations in the Hidden Zone

Abdelrahman

Seyed-Emadaldin

Krajnovic

et al. 2021

Global Spine Journal

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“…al. proposed a different, more conservative approach for the minimally invasive treatment of FLDH that would allow access to the foramen of conjugation only with minimal bony removal at the level of the isthmus: the trans pars interarticularis microscopic approach 17 . Although this approach is not entirely new, it has long been criticized both because of its learning curve and because, in the eyes of its detractors, for the possible di culty to manage any hernias that extend even medially, potentially thereby promoting the rate of recurrence in the absence, however, of speci c literature on the subject.…”

Section: Discussionmentioning

confidence: 99%

Recurrent or junctional lumbar foraminal herniated disc in patients operated withtrans pars microscopic approach

Monticelli

Gelmi

Scerrati

et al. 2023

Preprint

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Study design This is a retrospective monocentric studyObjective The aim of this study is to analyze the incidence of recurrent or junctional lumbar foraminal herniated disc, in patients treated with trans pars microsurgical approach.Background Foraminal lumbar disc herniation represents a challenging pathology for the spinal surgeon. The appropriate surgical approach still represents a matter of debate. Several open and minimally-invasive techniques have been developed, in order to allow a proper tissue exposure and preserving the vertebral stability. The trans-pars approach has already been described as a possible alternative, allowing excellent exposure of the herniated fragment with minimum bone removal. While few studies have analyzed the very low rate of post-operative instability, no articles deal with the incidence of post-operative herniated disc recurrence or junctional disc herniation in patients treated with this technique.Methods We enrolled 160 patients operated at our institution.A univariate and multivariate analysis of possible factors influencing outcome (age, sex, level and BMI) was performed. Outcome variables were: recurrent or junctional herniated disc. Results At the end 135 patients were analyzed. Of the 135 patients, six presented recurrent herniated disc (4.4%) and other three developed a junctional herniation (2.2%). The occurrence of junctional herniated disc or recurrent herniated disc were not influenced by the analyzed variables, both at univariate and at multivariate analysesConclusion The trans pars approach presents a low rate of recurrence and junctional herniation. Age, sex, level and BMI do not influence the recurrence rate, both at same level and at junctional level.

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Extra-laminar microscopic-assisted percutaneous nucleotomy (EL-MAPN) for the treatment of foraminal lumbar disc prolapse, a modified minimally invasive approach

Alhashash

Gendy

Shousha

2021

Arch Orthop Trauma Surg

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Transpars Microscopic Approach for the Treatment of Purely Foraminal Herniated Lumbar Disc

Abstract: 3.

Cited by 8 publications

References 21 publications

Trans-Tubular Translaminar Microscopic-Assisted Nucleotomy for Lumbar Disc Herniations in the Hidden Zone

Trans-Tubular Translaminar Microscopic-Assisted Nucleotomy for Lumbar Disc Herniations in the Hidden Zone

Recurrent or junctional lumbar foraminal herniated disc in patients operated withtrans pars microscopic approach

Extra-laminar microscopic-assisted percutaneous nucleotomy (EL-MAPN) for the treatment of foraminal lumbar disc prolapse, a modified minimally invasive approach

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