CT scan assessment of the pathway of the true lateral approach for transforaminal endoscopic lumbar discectomy

Lee, Dukhee; Kim, N. H.; Park, J.-B.; Hwang, Changju; Lee, C. S.; Kim, Y.-T.; Kang, Sang-Soo; Rhee, John M.

doi:10.1302/0301-620x.93b10.26833

Cited by 14 publications

(11 citation statements)

References 14 publications

(26 reference statements)

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“…For example, Ruetten et al [ 15 ] introduced the extreme lateral approach. Lee et al [ 10 ] reported that a true lateral approach for TELD would be possible if the patient was in the prone position, due to the ventral shift of the abdominal organs. However, the far lateral approach may increase the risk of retroperitoneal or visceral violations.…”

Section: Discussionmentioning

confidence: 99%

What Is the Ideal Entry Point for Transforaminal Endoscopic Lumbar Discectomy?

Lee

Park

Kim

et al. 2020

J Korean Neurosurg Soc

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Objective The method of approach during transforaminal endoscopic lumbar discectomy (TELD) has been the subject of repeated study. However, the ideal entry point during TELD has not been studied in detail. Therefore, this study investigated the ideal entry point for avoiding complications using computed tomography (CT) scans obtained from patients in the prone position. Methods Using CT scans obtained from patients in the prone position, we checked for retroperitoneal or visceral violations and measured the angles of approach with five conventional approach lines drawn on axial CT scans at each disc space level (L2–3, L3–4, and L4–5). We also determined the ideal entry point distance and approach angles for avoiding retroperitoneal or visceral violations. Correlation analysis was performed to identify the patient characteristics related to the ideal entry point properties. Results We found that the far lateral approach at the L2–3 level resulted in high rates of visceral violation. However, rates of visceral violation at the L3–4 and L4–5 levels were remarkably low or absent. The ideal angles of approach decreased moving caudally along the spine, and the ideal entry point distances increased moving caudally along the spine. Weight, body mass index (BMI), and the depth of the posterior vertebral line from the skin were positively associated with the distance of the ideal entry point from the midline. Conclusion We reviewed the risk of the extreme lateral approach by analyzing rates of retroperitoneal and visceral violations during well-known methods of approach. We suggested an ideal entry point at each level of the lumbar spine and found a positive correlation between the distance of the entry point to the midline and patient characteristics such as BMI, weight, and the depth of the posterior vertebral line from the skin.

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Section: Discussionmentioning

confidence: 99%

What Is the Ideal Entry Point for Transforaminal Endoscopic Lumbar Discectomy?

Lee

Park

Kim

et al. 2020

J Korean Neurosurg Soc

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“…The exit nerve is located on the ventral side of the inter-transverse-process ligament as a leg of the safety triangle, and the ligament is appropriately dissected to identify the nerve root. It is essential to locate the nerve root in a retrograde manner and preserve the nerve root during placement of the superior pedicle screw [16], [17]. Resection of the superior articular process can fully expose the intervertebral foramen, which is located distal to the dural sac and the inferior nerve root.…”

Section: Discussionmentioning

confidence: 99%

Digitalized Design of Extraforaminal Lumbar Interbody Fusion: A Computer-Based Simulation and Cadaveric Study

et al. 2014

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PurposeThis study aims to investigate the feasibility of a novel lumbar approach named extraforaminal lumbar interbody fusion (ELIF), a newly emerging minimally invasive technique for treating degenerative lumbar disorders, using a digitalized simulation and a cadaveric study.MethodsThe ELIF surgical procedure was simulated using the Mimics surgical simulator and included dissection of the superior articular process, dilation of the vertebral foramen, and placement of pedicle screws and a cage. ELIF anatomical measures were documented using a digitalized technique and subsequently validated on fresh cadavers.ResultsThe use of the Mimics allowed for the vivid simulation of ELIF surgical procedures, while the cadaveric study proved the feasibility of this novel approach. ELIF had a relatively lateral access approach that was located 8–9 cm lateral to the median line with an access depth of approximately 9 cm through the intermuscular space. Dissection of the superior articular processes could fully expose the target intervertebral discs and facilitate a more inclined placement of the pedicle screws and cage with robust enhancement.ConclusionsAccording to the computer-based simulation and cadaveric study, it is feasible to perform ELIF. Further research including biomechanical study is needed to prove ELIF has a superior ability to preserve the posterior tension bands of the spinal column, with similar effects on spinal decompression, fixation, and fusion, and if it can enhance post-fusion spinal stability and expedites postoperative recovery.

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“…The post-lateral approach involves partial resection of the lateral part of the isthmus for sufficient exposure of the disc, but the suitable range of resection has not been analyzed. [16,17] …”

Section: Introductionmentioning

confidence: 99%

Anatomic investigation of lumbar transforaminal fenestration approach and its clinical application in far lateral disc herniation

Xu²,

Destandau³

et al. 2017

Medicine

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Treating lumbar disease at the intervertebal foramina is controversial because we lack an approach providing sufficient exposure and preserving spinal stability. The primary objective of this study was to investigate the feasibility of the transforaminal fenestration (TFF) approach for treating lumbar disease involving the intervertebal foramina.In the anatomic study of 30 adult cadaveric lumbar spine specimens, the TFF approach was used from L1 to S1. The scope of resection was measured manually and on 3D CT images. 3D CT images of the lumbar spine of 31 adult patients were collected, and the scope of resection needed during the TFF approach was defined and measured from L1 to S1. In total, 30 patients (14 men) with lumbar FLDH underwent microendoscopic discectomy (MED) via the TFF approach. The results were evaluated with visual analog scale (VAS), Oswestry Disability Index (ODI), Short Form-36 survey (SF-36), and the MacNab scale.In cadavers, the TFF approach provided sufficient exposure to the posterolateral aspect of the disc and the exiting nerve root at all segments. At L1 to L4, a relatively small part of the isthmus and facet joint was resected; at L4 to S1, a relatively large part of the isthmus and facet joint was resected, so luniform fenestration was needed to preserve a more inferior articular process and continuity of the isthmus. Treatment with MED via the TFF approach was successful in the 30 patients with significantly relieved of symptom after operation. In total, 24 patients were followed for a mean of 24 months. The VAS, ODI, SF-36 physical component, and mental component summary scores at the final follow-up improved significantly compared with preoperative data (P < .05), and excellent results were obtained in 19 patients and good results in 6 according to the Macnab scale.The TFF approach can provide sufficient exposure to the lumbar intervertebal foramina with preservation of stability and can be used effectively with MED to treat lumbar FLDH.

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CT scan assessment of the pathway of the true lateral approach for transforaminal endoscopic lumbar discectomy

Cited by 14 publications

References 14 publications

What Is the Ideal Entry Point for Transforaminal Endoscopic Lumbar Discectomy?

What Is the Ideal Entry Point for Transforaminal Endoscopic Lumbar Discectomy?

Digitalized Design of Extraforaminal Lumbar Interbody Fusion: A Computer-Based Simulation and Cadaveric Study

Anatomic investigation of lumbar transforaminal fenestration approach and its clinical application in far lateral disc herniation

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