Combined intra-extracanal approach to lumbosacral disc herniations with bi-radicular involvement. Technical considerations from a surgical series of 15 cases

Paolini, Sergio; Ciappetta, Pasquale; Raco, Antonino; Missori, Paolo; Delfini, Roberto

doi:10.1007/s00586-004-0862-6

Cited by 17 publications

(15 citation statements)

References 18 publications

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“…Lesions that extend to the intracanal and foraminal areas can cause double radicular compression 17) . Such lesions are difficult to treat with surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Spinal stenosis or herniated nucleus pulposus (HNP) extending into both the intracanal and foraminal areas causes the development of biradicular symptoms, and several authors managed such conditions by performing a medial facetectomy or a total facetectomy 4 7) . Medial facetectomy has the drawback of controlling the neuroforamen on one side alone; thus, the presence of disc remnants within or outside the foramen cannot be excluded 17) . Additional partial facet removal in a lateral direction can lead to instability, and sometimes fusion surgery is required 13) .…”

Section: Introductionmentioning

confidence: 99%

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Combined Interlaminar and Paraisthmic Approach for Co-existing Intracanal and Foraminal Lesion

Lee

Woo²,

Jang

et al. 2015

Korean J Spine

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ObjectiveStenosis or herniated nucleus pulposus (HNP) occupying lumbar intracanal and foraminal area is an important cause of double radicular symptoms. Using the combined interlaminar and paraisthmic approach, we performed decompression surgery in patients with co-existing intracanal and foraminal lesions. The objective of this study is to describe usefulness and outcome of combined interlaminar and paraisthmic approach surgery and to analysis the cause of poor outcome.MethodsBetween Apr 2009 and Apr 2014, 78 patients (42 males and 36 females) with intracanal and foraminal lesions were enrolled in this study. Patients with a vacuum disc, spondylolisthesis, instability or an isthmic defect on the preoperative dynamic view radiograph were excluded from this study. All patients underwent surgery through a combined approach for discectomy and decompression. The outcome of surgery was evaluated and classified into excellent, good, fair and poor.ResultsThe results were excellent in 53 patients, good in 9, fair in 6 and poor in 10 during the follow-up. The outcome of the combined approach was excellent to fair in 87% (68 of 78) patients in our study. In the poor outcome group, three patients complained of early-onset relapsed pain (<1 month) and another seven patients complained of delayed-onset pain (>3 months).ConclusionCombined approach for both intracanal and foraminal area lesions may be useful if selectively performed on patients whose facet joint is relatively intact, and that it is worthy of consideration as an alternative to fusion surgery; however, further studies are needed.

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“…Lesions that extend to the intracanal and foraminal areas can cause double radicular compression 17) . Such lesions are difficult to treat with surgery.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Combined Interlaminar and Paraisthmic Approach for Co-existing Intracanal and Foraminal Lesion

Lee

Woo²,

Jang

et al. 2015

Korean J Spine

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“…2,4,5,7,8,10,13,15,17,18,20,21,24,25 Combining the advantages of the often used paramedian muscle-splitting approach and the endoscopic far-lateral approach, Greiner-Perth and coworkers described a minimally invasive variant of the paraspinal muscle-splitting approach and introduced a tubular working channel. 9 The technique was called the microscopeassisted technique.…”

Section: Discussionmentioning

confidence: 99%

Transtubular microsurgical approach to treating extraforaminal lumbar disc herniations

Eicker

Rhee²,

Steiger

et al. 2013

FOC

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Object Approaches to treating extraforaminal lumbar disc herniations can be challenging due to the unique anatomy and the need to prevent spinal instability. Numerous approaches, including conventional midline, paramedian, minimally invasive, and full endoscopic approaches, have been described. The purposes of this study were to point out the outcome and clinical advantages of a transtubular microsurgical approach and to describe and illustrate this technique. Methods Between 2009 and 2012, a series of 51 patients underwent a minimally invasive dilative transtubular microsurgical approach for the treatment of extraforaminal lumbar disc herniations. All patients were clinically evaluated using the visual analog scale (VAS) and Oswestry Disability Index preoperatively and 6 months postoperatively. Results Both pain scores and functional status showed significant improvement after surgery (p < 0.001): radicular pain decreased from VAS score of 7.9 to one of 1.3, lower back pain from VAS score of 2.4 to 1.4, and the Oswestry Disability Index from 42.0 to 12.3. Subgroup analyses revealed no differences in outcome regarding obesity or timing of surgery (early vs late intervention). Highly significant was the correlation between preoperative radicular pain activity and timing of surgical intervention (p < 0.001). Conclusions The dilative transtubular microsurgical approach combines the advantages of the conventional open muscle-splitting approach and the endoscopic approach. The technique is easy to use with a steep learning curve. Less muscle trauma and the absence of bony resection prevent facet pain and instability, thereby contributing to a rapid recovery. Patients in this series improved excellently in the short-term follow-up.

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“…The paper describing the combined intra-extracanal approach to lumbosacral disc herniations with biradicular involvement by Paolini [39] gives a beautifully illustrated description of this approach and its particular value if there has been previous surgery, and the disc protrusion is both paramedian, foraminal, and extraforaminal, and thus compressing both the exiting and the traversing root. Removal of these unusual protrusions by either approach alone is very unsatisfactory, and this paper describes the combined approach very clearly and concisely, with beautiful illustrations.…”

Section: Disc Surgerymentioning

confidence: 99%

A survey of the “surgical and research” articles in the European Spine Journal, 2006

Mulholland

2006

Eur Spine J

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Combined intra-extracanal approach to lumbosacral disc herniations with bi-radicular involvement. Technical considerations from a surgical series of 15 cases

Abstract: Large lumbosacral disc herniations effacing both the paramedian and the foraminal area often cause double radicular compression.

Cited by 17 publications

References 18 publications

Combined Interlaminar and Paraisthmic Approach for Co-existing Intracanal and Foraminal Lesion

Combined Interlaminar and Paraisthmic Approach for Co-existing Intracanal and Foraminal Lesion

Transtubular microsurgical approach to treating extraforaminal lumbar disc herniations

A survey of the “surgical and research” articles in the European Spine Journal, 2006

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