A novel translaminar crossover approach for pathologies in the lumbar hidden zone

Reinshagen, Clemens; Rueß, Daniel; Molcanyi, Marek; Redjal, Navid; Walcott, Brian P.; Goldbrunner, Roland; Rieger, Bernhard

doi:10.1016/j.jocn.2015.01.013

Cited by 19 publications

(11 citation statements)

References 29 publications

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“…• Resection of contralateral herniated disks in two 19 and eight patients. 20 • Resection of contralateral synovial cysts in 16 patients. 21 • Contralateral decompression in unilateral radiculopathy in 32 patients.…”

Section: Discussionmentioning

confidence: 99%

Facet-Sparing Decompression of Lumbar Spinal Stenosis: The Minimally Invasive Bilateral Crossover Approach

Klingler

Hubbe

Scholz

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Objective One risk of established decompression techniques for lumbar spinal stenosis is the resection of facet joints, especially if they are steeply configured, promoting destabilization. Minimally invasive bilateral crossover decompression aims to preserve the facet joints and thus stability of the spine. The purpose of this study is to demonstrate the feasibility and early results of this technique. Methods This retrospective case series includes 10 consecutive patients with lumbar stenosis and steep-angle (<35 degrees) facet joints who were treated with minimally invasive bilateral crossover decompression. Eleven segments were decompressed, most commonly L3/L4 (63.6%), followed by L1/L2 and L2/L3 (18.2% each). The effectiveness of surgical decompression was assessed by self-reporting questionnaires. Results After a follow-up of 10.5 months, the Symptom Severity Scale and Physical Function Scale of the Swiss Spinal Stenosis Questionnaire improved by 0.9 (p < 0.05) and 0.7 points, respectively. The mean Oswestry Disability Index improved from 53.9 to 34.6 (p < 0.05). Local and radiating pain under strain showed statistically significant improvement on the Visual Analog Scale (8.9 vs. 5.0 and 8.4 vs. 4.6, respectively). Maximum walking distance increased from 190 to 1,029 m. Apart from one patient requiring surgical decompression of an adjacent segment, there were no reoperations, neurological deteriorations, or other complications. Conclusion The results of this study indicate that minimally invasive bilateral crossover decompression is a promising technique for the treatment of spinal canal stenosis. With its design to spare facet joints, it can potentially reduce the risk of spinal instability, especially in patients with steep facet joints.

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Section: Discussionmentioning

confidence: 99%

Facet-Sparing Decompression of Lumbar Spinal Stenosis: The Minimally Invasive Bilateral Crossover Approach

Klingler

Hubbe

Scholz

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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“…Wang et al [ 17 ] described an approach called endoscopic transpedicle fenestration, with a bony hole drilled on the pedicle, sparing the lamina and facet joints. Reinshagen et al [ 18 ] introduced the microscopic translaminar crossover approach. An angled fenestration is created in the contralateral hemilamina, whereby the medial portion of the hemilamina, just at the base of the spinous, is targeted to the hidden zone on the symptomatic (ipsilateral) side.…”

Section: Discussionmentioning

confidence: 99%

Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

et al. 2021

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Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

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“…10,11 It may be possible to tailor the bony opening to minimize the likelihood of postoperative instability, especially with an experienced surgeon using a microscope. 10,12 However, up-and downward migrated sequestrations are difficult to reach and remove completely with a microscope, and they cannot be examined around the corner. Here the use of high-quality endoscopes provides better imaging and more precise control of surgery (complete removal of the herniated disk and avoidance of damages because the area of the migrated disk is fully visualized, in full HD quality, and very bright illumination through the endoscope).…”

Section: Discussionmentioning

confidence: 99%

Full Endoscopic Technique for High-Grade Up-Migrated Lumbar Disk Herniation via a Translaminar Keyhole Approach: Preliminary Series and Technical Note

Lin

Park²,

Suen

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Aims Technically and anatomically, accessing a high-grade migrated lumbar disk herniation (LDH) using traditional full endoscopic lumbar diskectomy (FELD) approaches (either transforaminal or interlaminar) is challenging. The objective of this study was to present an effective and safe surgical approach for high-grade up-migrated LDH by translaminar FELD. Patients and Methods Thirteen patients with soft high-grade up-migrated LDH treated with a translaminar FELD between May 2015 and July 2018 were reviewed in this study. Five of these patients had very high-grade up-migration. Clinical outcomes were assessed including preoperative and postoperative visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and MacNab criteria. Results Overall, 7 of the 13 patients had disk-fragment migration at L4–L5: three at L5–S1, two at L3–L4, and the remaining one at L2–L3. In all cases, the highly up-migrated LDH was removed successfully through the translaminar approach, as confirmed by postoperative magnetic resonance imaging. The improvements of VAS for back and leg pain were 4.5 ± 0.9 to 1.3 ± 1.3 and 7.1 ± 1.0 to 1.6 ± 0.7, respectively (both p < 0.05). The ODI decreased from preoperative 41.9 ± 6.0 to postoperative 13.0 ± 4.1 (p < 0.05). According to the MacNab criteria, the satisfaction rate was 92.3% (excellent or good outcomes). None of the patients experienced any perioperative complications or recurrence during the follow-up period. Conclusion Although full endoscopic technique via the translaminar keyhole route may not be used as a routine surgical approach, it could serve as a feasible alternative method for patients with highly up-migrated disk herniation.

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A novel translaminar crossover approach for pathologies in the lumbar hidden zone

Cited by 19 publications

References 29 publications

Facet-Sparing Decompression of Lumbar Spinal Stenosis: The Minimally Invasive Bilateral Crossover Approach

Facet-Sparing Decompression of Lumbar Spinal Stenosis: The Minimally Invasive Bilateral Crossover Approach

Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

Full Endoscopic Technique for High-Grade Up-Migrated Lumbar Disk Herniation via a Translaminar Keyhole Approach: Preliminary Series and Technical Note

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