Lateral transmuscular or combined interlaminar/paraisthmic approach to lateral lumbar disc herniation? A comparative clinical series of 48 patients

Abstract

Background: The optimum operative technique for lateral lumbar disc herniations (LLDH) remains unclear, and both interlaminar and extraspinal approaches are used. Objective: To compare outcome after LLDH removal either by a lateral transmuscular approach (LTM) or by a combined interlaminar and paraisthmic approach (CIP). Methods: 28 patients underwent surgery using CIP and 20 using LTM. All patients were operated on by the same neurosurgeon. The clinical presentation of the two groups was comparable. Overall outcome was assessed after a mean follow up period of between 19 and 37 months using the Ebeling classification. In addition, the effect of surgery on radicular pain, low back pain, and sensory and motor deficits was defined.Results: Excellent to good results were achieved in 95% of the LTM group and 57% of the CIP group. The outcome was satisfactory to poor in 5% of the LTM and 43% of the CIP group (p,0.004). The percentage of sensorimotor deficit and of radicular pain improvement was higher in the LTM group. New low back pain was found exclusively in the CIP group (21%). The complication rate was 5% in the LTM group and 11% in the CIP group. Conclusions: The LTM approach achieves a better overall outcome and improvement in radiculopathy. The complication rate is lower with the transmuscular route and the risk of new low back pain is minimised. These results are likely to be attributable at least in part to the lesser invasiveness of the LTM approach.

Ultra-long-term outcome of surgically treated far-lateral, extraforaminal lumbar disc herniations: a single-center series

“…Remarkable in this regard is the study carried out by Ryang and colleagues. Performing a lateral approach, they achieved 95% good or excellent results, whereas merely 57% of their patients had such a positive outcome if treated with a medial procedure [21]. Also noteworthy is the study performed by Kunogi.…”

“…This means that complications are apparently more than twice as often with medial procedures. More serious were the complications reported by Sasani [21]. In two (3%) of his endoscopically treated 66 patients, the nerve roots were partially damaged, and in another two the nerve roots were impinged by the working channel.…”

“…A similar complication rate of 5% was found by Ryang, when a lateral approach was performed. It was 11%, however, if the patients were treated via a medial approach [21]. This means that complications are apparently more than twice as often with medial procedures.…”

“…Furthermore, these extensive approaches may contribute to continued postoperative discomfort. A comparison of the lateral and medial approach demonstrated significantly better results for the lateral approach [9,21]. Its surgical realization, however, is more demanding owing to its less familiar route and the absence of the usual anatomical landmarks known from medial approaches.…”

Mapeamento do trajeto extraforaminal da raiz L4 no espaço intertransversário L4-L5 através do acesso paramediano à coluna vertebral

“…Poor surgical fam i l i a r i t y, d e e p dissection, poor visualization, difficulties in enucleating intervertebral disc, and the potential risk of injury to emergent nervous root are some of its disadvantages. Although scarce, studies comparing techniques evidenced better results when the t r a n s m u s c u l a r lateral port was performed for extraforaminal discectomy (16) . Once the intertransversal L4-L5 space is reached and the intertransversal membrane is res- …”