Surgical treatment of intraforaminal/extraforaminal lumbar disc herniations: Many approaches for few surgical routes

Lofrese, Giorgio; Mongardi, Lorenzo; Cultrera, Francesco; Trapella, Giorgio; Bonis, Pasquale De

doi:10.1007/s00701-017-3198-9

Cited by 15 publications

(15 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Over the years, literature on the classification of lumbar disc herniation hasn't been properly systematized, making the issue debated and confusing [6][7][8][9][10][11][12][13][14][15][16][17][18] , with the exception of some papers, pointy classifying them based on the anatomic relationships with the foraminal area 3,19,20 .…”

Section: Discussionmentioning

confidence: 99%

“…Microsurgical techniques comprise partial facetectomy, the trans-articular, the trans-pars-interarticularis, the combined translaminar-transpars-interarticularis, and the contralateral interlaminar approach. The recent development of endoscopic techniques has led to the conception of the endoscopic transforaminal approach 3 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…The description of the specific surgical technique of partial facetectomy, trans-articular, trans-pars-interarticularis, combined translaminar-trans-pars-interarticularis, and contralateral interlaminar approach is beyond the aims of the present study and was already extensively discussed in other reports 3 .…”

Section: Surgical Techniquementioning

confidence: 99%

See 2 more Smart Citations

Comparative Analysis on Surgical Operability and Degree of Exposure of Microsurgical Approaches to Intraforaminal Lumbar Disk Herniations

Gagliardi

Pompeo

Snider

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

IFDHs (intraforaminal disc herniations) represent a heterogeneous and relatively uncommon disease; their treatment is technically demanding due to the anatomic relationships with nerve roots and vertebral joints. Over time, several approaches have been developed without reaching a consensus about the best treatment strategy. Authors comparatively analyze surgical operability and exposure in terms of quantitative variables between the different microsurgical approaches to intraforaminal lumbar disc herniations (IFDH), defining the impact of each approach on surgical maneuverability and exposure on specific targets. A comparative microanatomical laboratory investigation was conducted. The operability score (OS) was applied for quantitative analysis of surgical operability. Trans-articular and combined translaminar-trans-pars-interarticularis approaches result in providing the best surgical exposure and maneuverability on all targets with surgical controls on both nerve roots, at the expense of a higher risk of iatrogenic instability. Trans-pars-interarticularis approach reaches comparable levels of operability, even limited to the pure foraminal area (lateral compartment); similar findings were recorded for partial facetectomy on the medial compartment. The contralateral interlaminar approach provides good visualization of the foramen without consensual favorable maneuverability, which should be considered as the main drawback. Approach selection has to consider disease location, the possible migration of disc fragments, the degree of nerve root involvement, and risk of iatrogenic instability. According to the findings, authors propose an operative algorithm to tailor the surgical strategy, based both on the precise definition of anatomic boundaries of exposure of each approach, as well as surgical maneuverability on specific targets.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

See 1 more Smart Citation

Comparative Analysis on Surgical Operability and Degree of Exposure of Microsurgical Approaches to Intraforaminal Lumbar Disk Herniations

Gagliardi

Pompeo

Snider

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

show abstract

“…Ethics approval was deemed unnecessary according to the hospital’s published Institutional Review Board. Additionally, this novel tweak is covered within the confines of the existing previously described approach to far lateral disc herniation without deviation from the standard of care [ 4 ].…”

Section: Methodsmentioning

confidence: 99%

“…The use of minimally invasive retractor systems has significantly decreased the amount of tissue dissection and blood loss, and the duration of post-operative recovery for far-lateral disc herniations (FLDH) [ 1 , 2 , 3 ]. There are various techniques for docking the tubular retractor, including on the facet joint, pars interarticularis, and the cranial transverse process (TP) [ 4 ]. The challenges for a minimally invasive surgery for FLDH consist in limited bony landmarks compared to soft-tissue elements, which results in a variation of where to dock the retractor [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

A Modified Approach for Minimally Invasive Tubular Microdiscectomy for Far Lateral Disc Herniations: Docking at the Caudal Level Transverse Process

2022

View full text Add to dashboard Cite

Background and Objectives: The use of minimally invasive retractor systems has significantly decreased the amount of tissue dissection and blood loss, and the duration of post-operative recovery after far-lateral disc herniations (FLDH). In this technical note, the technique of docking the tubular retractor on the caudal transverse process is described for an efficient approach with a decreased need for manipulation of the exiting nerve root. Materials and Methods: The case reported is that of a woman affected by a right-sided FLDH at the L4–5 level causing an L4 radiculopathy with weakness and numbness. A review of the literature for FLDH regarding the key anatomy used during a far lateral approach was also performed. Results: The patient showed a significant improvement of her dorsiflexion weakness and radiating leg pain at her 2-week and 5-week post-operative visits, and at a 6-month follow-up she had near-complete relief of her symptoms, including resolution of foot numbness. Prior techniques for tubular microdiscectomy for FLDH report docking on the facet joint, pars interarticularis, and the cranial transverse process. Conclusions: This technical note details that the utility of docking a tubular retractor at the caudal transverse process improves upon already established techniques for minimally invasive tubular discectomy for FLDH.

show abstract

Recurrent or junctional lumbar foraminal herniated disc in patients operated with trans pars microscopic approach

Monticelli,

Gelmi,

Scerrati

et al. 2023

Neurosurg Rev

Self Cite

View full text Add to dashboard Cite

This is a retrospective monocentric study. The aim of this study is to analyze the incidence of recurrent or junctional lumbar foraminal herniated disc, in patients treated with trans pars microsurgical approach. Foraminal lumbar disc herniation represents a challenging pathology for the spinal surgeon. The appropriate surgical approach still represents a matter of debate. Several open and minimally-invasive techniques have been developed, in order to allow a proper tissue exposure and preserving the vertebral stability. The trans pars approach has already been described as a possible alternative, allowing excellent exposure of the herniated fragment with minimum bone removal. While few studies have analyzed the very low rate of post-operative instability, no articles deal with the incidence of post-operative herniated disc recurrence or junctional disc herniation in patients treated with this technique. We enrolled 160 patients operated at our institution. A univariate and multivariate analysis of possible factors influencing outcome (age, sex, level and BMI) was performed. Outcome variables were recurrent or junctional herniated disc. At the end, 135 patients were analyzed. Of the 135 patients, six presented recurrent herniated disc (4.4%) and other three developed a junctional herniation (2.2%). The occurrence of junctional herniated disc or recurrent herniated disc was not influenced by the analyzed variables, both at univariate and at multivariate analyses. The trans pars approach presents a low rate of recurrence and junctional herniation. Age, sex, level, and BMI do not influence the recurrence rate, both at same level and at junctional level.

show abstract

Surgical treatment of intraforaminal/extraforaminal lumbar disc herniations: Many approaches for few surgical routes

Abstract: The integration of adequate mastery of traditional approaches together with a greater confidence through unfamiliar surgical corridors can improve the development of combined mini-invasive procedures, which seem promising for future targeted LDH excisions.

Cited by 15 publications

References 70 publications

Comparative Analysis on Surgical Operability and Degree of Exposure of Microsurgical Approaches to Intraforaminal Lumbar Disk Herniations

Comparative Analysis on Surgical Operability and Degree of Exposure of Microsurgical Approaches to Intraforaminal Lumbar Disk Herniations

A Modified Approach for Minimally Invasive Tubular Microdiscectomy for Far Lateral Disc Herniations: Docking at the Caudal Level Transverse Process

Recurrent or junctional lumbar foraminal herniated disc in patients operated with trans pars microscopic approach

Contact Info

Product

Resources

About