Download PDF
J Neurol Surg A Cent Eur Neurosurg 2021; 82(01): 027-033
DOI: 10.1055/s-0040-1714367
Original Article

Surgical Outcomes of Extraforaminal Microdiskectomy by Midline Incision for Far-Lateral Lumbar Disk Herniation

Ismail Yüce
1   Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar Universitesi, Istanbul, Turkey
,
Okan Kahyaoğlu
2   Acibadem Healthcare Group, Fulya Hospital, Istanbul, Turkey
,
Halit Çavuşoğlu
1   Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar Universitesi, Istanbul, Turkey
,
Yunus Aydın
2   Acibadem Healthcare Group, Fulya Hospital, Istanbul, Turkey
› Author Affiliations Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
› Further Information
    Permissions and Reprints

Abstract

Background Far-lateral lumbar disk herniation (FLDH) is defined as a disk herniation located laterally to the medial wall of the pedicle. The aim of our study is to describe the extraforaminal microdiskectomy by midline incision for FLDH, which does not include laminotomy–partial facetectomy, and to evaluate mid-term surgical outcomes.

Methods 107 patients who underwent surgery for FLDH by midline incision for the first time between 2012 and 2017 were included in our study. The assessment of neurological status of the patients was done by physical examination, preoperative Oswestry Disability Index (ODI), Visual Analog Scala (VAS) scores, and magnetic resonance images. They were then followed-up postoperatively and at 12 months with VAS and ODI tests.

Result 58 (54.2%) patients were male and 49 (45.8%) were female. The mean age at the time of surgery was 55.0 ± 8.6 years. The mean ODI scale score was 32.4 ± 6.2 preoperatively, 11.4 ± 2.1 early postoperatively, and 9.7 ± 2.2 in late postoperative follow-up (statistically significant, p = 0.001). The average VAS was 7.51 ± 1.1 preoperatively, 2.74 ± 0.7 early postoperatively, and 0.68 ± 0.08 in late postoperative follow-up (statistically significant, p = 0.001). The average operative time was 41 ± 7 (37 to 58) minutes.

Conclusions The extraforaminal microdiskectomy without laminotomy by midline incision is a minimally invasive approach for FLDH. Our technique allows a sufficient and safe decompression of the neural structures, and thus results in a significant reduction of the symptoms and disability

Keywords

Far-Lateral Lumbar Disk Herniation - minimally invasive approach - microdiskectomy - midline incision - surgical outcomes

Informed Consent

Informed consent was obtained from all individual participants included in the study.


Ethical Approval

This study was performed with clinical data collected from patient files collected retrospectively. For this type of study, formal consent is not required. All patients were informed for the procedure and the study.




Publication History

Received: 29 May 2019

Accepted: 02 December 2019

Article published online:
06 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Benini A. Der Zugang zu den lateralen lumbalen Diskushernien am Beispiel einer Hernie L4/L5. Operative Orthopädie und Traumatologie 1998; 10: 103-116
    CrossrefPubMedGoogle Scholar
  • 2 Cervellini P, De Luca GP, Mazzetto M, Colombo F. Micro-endoscopic-discectomy (MED) for far lateral disc herniation in the lumbar spine.. Technical note. Acta Neurochir 2005; 92: 99-101
    CrossrefPubMedGoogle Scholar
  • 3 Lew SM, Mehalic TF, Fagone KL. Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations. J Neurosurg 2001; 94 (02) 216-220
    CrossrefPubMedGoogle Scholar
  • 4 Kunogi J, Hasue M. Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine 1991; 16 (11) 1312-1320
    CrossrefPubMedGoogle Scholar
  • 5 Kurobane Y, Takahashi T, Tajima T. et al. Extraforaminal disc herniation. Spine 1986; 11 (03) 260-268
    CrossrefPubMedGoogle Scholar
  • 6 Porchet F, Chollet-Bornand A, de Tribolet N. Long-term follow up of patients surgically treated by the far-lateral approach for foraminal and extraforaminal lumbar disc herniations. J Neurosurg 1999; 90 (01) 59-66
    CrossrefPubMedGoogle Scholar
  • 7 Abdullah AF, Ditto III EW, Byrd EB, Williams R. Extreme-lateral lumbar disc herniations: clinical syndrome and special problems of diagnosis. J Neurosurg 1974; 41 (02) 229-234
    CrossrefPubMedGoogle Scholar
  • 8 O'Hara LJ, Marshall RW. Far lateral lumbar disc herniation: the key to the intertransverse approach. J Bone Joint Surg Br 1997; 79 (06) 943-947
    CrossrefPubMedGoogle Scholar
  • 9 Viswanathan R, Swamy NK, Tobler WD, Greiner AL, Keller JT, Dunsker SB. Extraforaminal lumbar disc herniations: microsurgical anatomy and surgical approach. J Neurosurg 2002; 96 (02) 206-211
    CrossrefPubMedGoogle Scholar
  • 10 Maroon JC, Kopitnik TA, Schulhof LA, Abla A, Wilberger JE. Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine. J Neurosurg 1990; 72 (03) 378-382
    CrossrefPubMedGoogle Scholar
  • 11 Reulen HJ, Pfaundler S, Ebeling U. The lateral microsurgical approach to the “extracanalicular” lumbar disc herniation. I: A technical note. Acta Neurochir (Wien) 1987; 84 (1-2): 64-67
    CrossrefPubMedGoogle Scholar
  • 12 Watkins MB. Posterolateral fusion in pseudarthrosis and posterior element defects of the lumbosacral spine. Clin Orthop Relat Res 1964; 35 (35) 80-85
    PubMedGoogle Scholar
  • 13 Wiltse LL, Spencer CW. New uses and refinements of the paraspinal approach to the lumbar spine. Spine 1988; 13 (06) 696-706
    CrossrefPubMedGoogle Scholar
  • 14 Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 2008; 8 (06) 968-974
    CrossrefPubMedGoogle Scholar
  • 15 Panjabi MM, Krag MH, Goel VK. A technique for measurement and description of three-dimensional six degree-of-freedom motion of a body joint with an application to the human spine. J Biomech 1981; 14 (07) 447-460
    CrossrefPubMedGoogle Scholar
  • 16 Abdullah AF, Wolber PG, Warfield JR, Gunadi IK. Surgical management of extreme lateral lumbar disc herniations: review of 138 cases. Neurosurgery 1988; 22 (04) 648-653
    CrossrefPubMedGoogle Scholar
  • 17 Greiner-Perth R, Böhm H, Allam Y. A new technique for the treatment of lumbar far lateral disc herniation: technical note and preliminary results. Eur Spine J 2003; 12 (03) 320-324
    CrossrefPubMedGoogle Scholar
  • 18 Epstein NE. Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results. J Neurosurg 1995; 83 (04) 648-656
    CrossrefPubMedGoogle Scholar
  • 19 Gioia G, Mandelli D, Capaccioni B, Randelli F, Tessari L. Surgical treatment of far lateral lumbar disc herniation: identification of compressed root and discectomy by lateral approach. Spine 1999; 24 (18) 1952-1957
    CrossrefPubMedGoogle Scholar
  • 20 Caspar W. A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. In: Wüllenweber R, Brock M, Hamer J. eds. Advances in Neurosurgery. Berlin: Springer; 1977: 74-77
  • 21 Destandau J. A special device for endoscopic surgery of lumbar disc herniation. Neurol Res 1999; 21 (01) 39-42
    CrossrefPubMedGoogle Scholar
  • 22 Foley KT, Smith MM. Microendoscopic discectomy. Tech Neurosurg 1997; 3: 301-307
    PubMedGoogle Scholar
  • 23 Tessitore E, de Tribolet N. Far-lateral lumbar disc herniation: the microsurgical transmuscular approach. Neurosurgery 2004; 54 (04) 939-942 , discussion 942
    CrossrefPubMedGoogle Scholar
  • 24 Donaldson III WF, Star MJ, Thorne RP. Surgical treatment for the far lateral herniated lumbar disc. Spine 1993; 18 (10) 1263-1267
    CrossrefPubMedGoogle Scholar
  • 25 Hodges SD, Humphreys SC, Eck JC, Covington LA. The surgical treatment of far lateral L3-L4 and L4-L5 disc herniations: a modified technique and outcomes analysis of 25 patients. Spine 1999; 24 (12) 1243-1246
    CrossrefPubMedGoogle Scholar
  • 26 Schwetlick G. Mikrochirurgische lumbale Bandscheibenoperationen. Orthopade 1998; 27: 457-465
    CrossrefPubMedGoogle Scholar
  • 27 Perez-Cruet MJ, Foley KT, Isaacs RE. et al. Microendoscopic lumbar discectomy: technical note. Neurosurgery 2002; 51 (05) S129-S136
    PubMedGoogle Scholar
  • 28 O'Toole JE, Eichholz KM, Fessler RG. Minimally invasive far lateral microendoscopic discectomy for extraforaminal disc herniation at the lumbosacral junction: cadaveric dissection and technical case report. Spine J 2007; 7 (04) 414-421
    CrossrefPubMedGoogle Scholar
  • 29 Goffin J. Microdiscectomy for lumbar disc herniation. Clin Neurol Neurosurg 1994; 96 (02) 130-134
    CrossrefPubMedGoogle Scholar