Transtubular microsurgical approach to treating extraforaminal lumbar disc herniations

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Both pain scores and functional status showed significant improvement after surgery (p &lt; 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 &lt; 0.001).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec>

Retrospective Analysis of Paraspinal Muscle-Splitting Microscopic-Assisted Discectomy Versus Percutaneous Endoscopic Lumbar Discectomy on Patients in the Treatment of Far-Lateral Lumbar Disc Herniation

“…In this study, the average duration of hospitalization was 98.64 ± 15.65 hours, which is longer than the PELD group due to intratracheal anesthesia. Compared with conventional paramedian muscle-splitting approaches, trans-tubular microsurgery has the advantage of using a sequential dilator and nally a tubular retractor, which allows procedures in obese patients fast and simple compared to thin patients [28] . In our department, the surgeons separate the paraspinal muscles using ngers.…”

The Modified Wiltse Approach for Treatment of Extraforaminal Disc Herniation in the Lumbar Spine

“…В связи с отсутствием резервного объема и ограниченности экстрафораминальной части корешка небольшая экстрафораминальная грыжа диска вызывает более серьезные симптомы [6,8].…”

“…После удаления фасеточного сустава может развиться нестабильность в оперированном позвоночно-двигательном сегменте, требующая в дальнейшем проведения стабилизирующего вмешательства [13,14]. Одним из доступов к экстрафораминальной части межпозвонкового диска является модифицированный доступ Wiltse, который позволяет осуществить полную эвакуацию экстрафораминального участка диска [5,6,8,10,16,19].…”

Minimal Superior Articular Process Removal of Facet Joint in Lateral Interpedincular Approach Could Provide a Better Exposure in Far Lateral Disc Herniation Treatment: A Technical Report

“…A far lateral lumbar disc herniation (FLLDH) is building of the disc material into the area that is lateral to the superior and inferior pedicles (1) . A FLLDH causes exiting nerve root compression, contrary to paramedian discs, which compress the nerve root at the level below (2) .…”

“…Clinical characteristics of FLLDHs differentiated from paramedian disc herniations, such as sharper radicular pain due to direct compression of the dorsal root ganglion and acute onset (16) . Compression of the exiting nerve root and dorsal root ganglion causes some clinical symptoms (1) . Compared to paramedian disc herniations, FLLDHs are more prone to be at the upper lumbar levels and to have adjacent pathologies like paramedian or foraminal disc herniations and spinal stenosis at the same level (16) .…”