Download PDF
J Neurol Surg A Cent Eur Neurosurg 2022; 83(06): 511-515
DOI: 10.1055/s-0041-1739221
Original Article

The Contralateral Approach to intra- and Extraforaminal Lumbar Disk Herniations: Surgical Technique and Review of Surgical Procedures

Christopher Marvin Jesse 
1   Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Andreas Raabe
1   Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Christian T. Ulrich
1   Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
2   Department of Neurosurgery, Lindenhofspital, Bern, Switzerland
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Background Surgery for intra-/extraforaminal disk herniations (IEDH) is technically demanding due to the hidden location of the compressed nerve root section. Ipsilateral approaches (medial and lateral) are accompanied by extended resection of the facet joint and inadequate visualization of the pathology, especially at the L5–S1 level.

Methods We describe a microsurgical interlaminar contralateral approach (MICA) suitable for IEDH at the lumbosacral junction that can also be used at L4–L5 and L3–L4.

Conclusion The MICA provides access and sufficient intraforaminal visualization for IEDH in the lumbosacral region without resection of stability-relevant structures or manipulation of the nerve root ganglion.

Keywords

Contralateral approach - lumbar disk herniation - intraforaminal disk herniation - MICA - IEDH


Publication History

Received: 11 November 2020

Accepted: 23 April 2021

Article published online:
12 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Epstein NE. Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures. Spinal Cord 2002; 40 (10) 491-500
    CrossrefPubMedGoogle Scholar
  • 2 Ahuja S, Moideen AN, Dudhniwala AG, Karatsis E, Papadakis L, Varitis E. Lumbar stability following graded unilateral and bilateral facetectomy: a finite element model study. Clin Biomech (Bristol, Avon) 2020; 75: 105011
    CrossrefPubMedGoogle Scholar
  • 3 Pal D, Tyagi AK. Interlaminar approach for excision of lateral lumbar disc herniation: technical note. Spine 2006; 31 (04) E114-E116
    CrossrefPubMedGoogle Scholar
  • 4 Yeom JS, Kim KH, Hong SW. et al. A minimally invasive technique for L5-S1 intraforaminal disc herniations: microdiscectomy with a tubular retractor via a contralateral approach. J Neurosurg Spine 2008; 8 (02) 193-198
    CrossrefPubMedGoogle Scholar
  • 5 Berra LV, Foti D, Ampollini A, Faraca G, Zullo N, Musso C. Contralateral approach for far lateral lumbar disc herniations: a modified technique and outcome analysis of nine patients. Spine 2010; 35 (06) 709-713
    CrossrefPubMedGoogle Scholar
  • 6 Zekaj E, Menghetti C, Saleh C. et al. Contralateral interlaminar approach for intraforaminal lumbar degenerative disease with special emphasis on L5-S1 level: a technical note. Surg Neurol Int 2016; 7: 88
    CrossrefPubMedGoogle Scholar
  • 7 Reinshagen C, Ruess D, Molcanyi M. et al. A novel translaminar crossover approach for pathologies in the lumbar hidden zone. J Clin Neurosci 2015; 22 (06) 1030-1035
    CrossrefPubMedGoogle Scholar
  • 8 James A, Laufer I, Parikh K, Nagineni VV, Saleh TO, Härtl R. Lumbar juxtafacet cyst resection: the facet sparing contralateral minimally invasive surgical approach. J Spinal Disord Tech 2012; 25 (02) E13-E17
    CrossrefPubMedGoogle Scholar
  • 9 Rhee J, Anaizi AN, Sandhu FA, Voyadzis JM. Minimally invasive resection of lumbar synovial cysts from a contralateral approach. J Neurosurg Spine 2012; 17 (05) 453-458
    CrossrefPubMedGoogle Scholar
  • 10 Sukkarieh HG, Hitchon PW, Awe O, Noeller J. Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases. J Neurosurg Spine 2015; 23 (04) 444-450
    CrossrefPubMedGoogle Scholar
  • 11 Postacchini F, Cinotti G, Gumina S. Microsurgical excision of lateral lumbar disc herniation through an interlaminar approach. J Bone Joint Surg Br 1998; 80 (02) 201-207
    CrossrefPubMedGoogle Scholar
  • 12 Jha RT, Syed HR, Catalino M, Sandhu FA. Contralateral Approach for Minimally Invasive Treatment of Upper Lumbar Intervertebral Disc Herniation: Technical Note and Case Series. World neurosurgery 2017; 100: 583-589
    CrossrefPubMedGoogle Scholar