Incidence of Iatrogenic Lumbar Spinal Instability after Laminectomy, Discectomy or Facetectomy

Hafez, Ahmed; Ashry, Ahmed Hamdy; Elsayed, Ahmed S.; Tayeb, Amr El; ElShenawy, Mohamed Badran Abdel Salam

doi:10.3889/oamjms.2021.6256

Cited by 3 publications

(1 citation statement)

References 16 publications

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“…Traditional anterior and posterior approaches were considered in our patient. Given her age and BMI, a posterior approach with hemilaminectomy and medial facetectomy was felt to present considerable risk of postoperative instability necessitating instrumentation and fusion [19]. Lateral transpsoas approaches are not without risk of injury to the lumbosacral plexus due its proximity, which moves more anteriorly at lower levels [20].…”

Section: A a B Bmentioning

confidence: 99%

Minimally Invasive Oblique Retroperitoneal Approach for Extraforaminal Lumbar Schwannoma: Technical Challenges and Literature Review

Kramer,

Elhamdani,

Zaki

et al. 2024

J Minim Invasive Spine Surg Tech

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Traditional surgical techniques for extradural lumbar schwannomas are associated with considerable morbidity, including spinal instability and injury to the viscera and lumbar plexus. Minimally invasive approaches decrease soft tissue damage, blood loss, and postoperative length of stay. For select extraforaminal schwannomas, a minimally invasive lateral transpsoas approach affords a direct surgical corridor. A 53-year-old obese female presented with 1 year of left iliopsoas weakness and L3 radiculopathy refractory to conservative management. Lumbar spine magnetic resonance imaging revealed a contrast-enhancing mass within the left psoas muscle consistent with an extraforaminal L3 schwannoma. The patient underwent minimally invasive oblique retroperitoneal surgical resection. Intraoperatively, the nerve root was splayed over the superior-lateral portion of the tumor limiting us to subtotal resection with nerve root preservation. The patient had improvement of pain and weakness that persisted at a 3-month follow-up. A minimally invasive lateral/oblique transpsoas approach provides a direct surgical approach for extraforaminal schwannoma. Patient body habitus and the nerve root relationship to the tumor may present limitations for the safe extent of resection.

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Section: A a B Bmentioning

confidence: 99%

Minimally Invasive Oblique Retroperitoneal Approach for Extraforaminal Lumbar Schwannoma: Technical Challenges and Literature Review

Kramer,

Elhamdani,

Zaki

et al. 2024

J Minim Invasive Spine Surg Tech

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Foraminal and far lateral lumbar disc herniation: outcome of unilateral full facetectomy with instrumented fusion

Elnaggar,

Habib

2024

Egypt J Neurosurg

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Background Far lateral lumbar disc herniation is a clinical condition characterized by nerve root compression out of the spinal canal, in its extraforaminal/extracanalicular course at the inferior or lateral aspect of the facet joint. Objective To analyze the effect of unilateral full facetectomy with instrumented fusion in management of foraminal and far lateral lumbar disc herniation. Methods This retrospective trial carried out on 34 cases (24 males, 10 females) aged from 27 to 68, with mean value of 49 years who were entered to the Neurosurgery Department, Menoufia University Hospital from January 2018 and January 2022. All patients suffered from foraminal and/or far lateral lumbar disc herniation and were treated with unilateral full facetectomy with instrumented fusion. Results The herniation level was at L2-3, L3-4, L4-5, and L5-S1 in 2, 10, 18, and 4 patients, respectively. Overall, the mean preoperative VAS score decreased from 8.6 to 2.3 in the short-term. When the long-term functional outcome following surgery was analyzed according to the MacNab Criteria, the recovery was excellent, good, fair, and poor in 26, 8, 0, and 0, respectively. Conclusions Full facetectomy ± laminectomy technique provides direct visualization of the complete course of the nerve root extending far laterally to avoid missed disc fragments and protect the nerve root from inadvertent trauma. Pedicle fixation for stabilization following full facetectomy has been indicated to avoid postoperative pain syndromes due to `micro-instability'.

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Advancing insights into recurrent lumbar disc herniation: A comparative analysis of surgical approaches and a new classification

Musa,

Abakirov,

Chmutin

et al. 2024

Journal of Craniovertebral Junction and Spine

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Background: The management of recurrent lumbar disc herniation (rLDH) lacks a consensus. Consequently, the choice between repeat microdiscectomy (MD) without fusion, discectomy with fusion, or endoscopic discectomy without fusion typically hinges on the surgeon’s expertise. This study conducts a comparative analysis of postoperative outcomes among these three techniques and proposes a straightforward classification system for rLDH aimed at optimizing management. Patients and Methods: We examined the patients treated for rLDH at our institution. Based on the presence of facet resection, Modic-2 changes, and segmental instability, they patients were categorized into three groups: Types I, II, and III rLDH managed by repeat MD without fusion, MD with transforaminal lumbar interbody fusion (TLIF) (MD + TLIF), and transforaminal endoscopic discectomy (TFED), respectively. Results: A total of 127 patients were included: 52 underwent MD + TLIF, 50 underwent MD alone, and 25 underwent TFED. Recurrence rates were 20%, 12%, and 0% for MD alone, TFED, and MD + TLIF, respectively. A facetectomy exceeding 75% correlated with an 84.6% recurrence risk, while segmental instability correlated with a 100% recurrence rate. Modic-2 changes were identified in 86.7% and 100% of patients experiencing recurrence following MD and TFED, respectively. TFED exhibited the lowest risk of durotomy (4%), the shortest operative time (70.80 ± 16.5), the least blood loss (33.60 ± 8.1), and the most favorable Visual Analog Scale score, and Oswestry Disability Index quality of life assessment at 2 years. No statistically significant differences were observed in these parameters between MD alone and MD + TLIF. Based on this analysis, a novel classification system for recurrent disc herniation was proposed. Conclusion: In young patients without segmental instability, prior facetectomy, and Modic-2 changes, TFED was available should take precedence over repeat MD alone. However, for patients with segmental instability, MD + TLIF is recommended. The suggested classification system has the potential to enhance patient selection and overall outcomes.

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Incidence of Iatrogenic Lumbar Spinal Instability after Laminectomy, Discectomy or Facetectomy

Cited by 3 publications

References 16 publications

Minimally Invasive Oblique Retroperitoneal Approach for Extraforaminal Lumbar Schwannoma: Technical Challenges and Literature Review

Minimally Invasive Oblique Retroperitoneal Approach for Extraforaminal Lumbar Schwannoma: Technical Challenges and Literature Review

Foraminal and far lateral lumbar disc herniation: outcome of unilateral full facetectomy with instrumented fusion

Advancing insights into recurrent lumbar disc herniation: A comparative analysis of surgical approaches and a new classification

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