Transmuscular Trocar Technique - Minimal Access Spine Surgery for Far Lateral Lumbar Disc Herniations

Abstract

Minimal access spine surgery (MASS) is gaining increasing importance in microsurgery of the lumbar spine. From a current prospective series we present data on MASS for far lateral lumbar disc herniations (LLDH) via a transmuscular trocar technique (T(2)). The surgical procedure and operative results are demonstrated in detail. In contrast to conventional percutaneous endoscopic techniques, T(2) allows one to operate in the typical microsurgical fashion combined with the advantages of a minimal endoscopic approach with three-dimensional visualization of the surgical target using the operating microscope. Microsurgery was performed through a 1.6-cm skin incision with an 11.5-mm diameter trocar that is obliquely inserted into the paraspinal muscles pointing at the lateral isthmus of the upper vertebral body. Fifteen patients were evaluated after a median follow-up period of 24 months. Overall outcome according to the modified MacNab criteria, effect of surgery on radicular pain and sensory or motor deficits, duration of surgery, complication rate, and duration of hospital stay were evaluated. Good to excellent clinical outcomes were achieved in 14/15 patients. Radicular pain and motor deficits improved in all patients postoperatively, while sensory deficits recovered in 13/15 patients. The cosmetic results were excellent in all patients. No aggravation of symptoms after surgery was observed in any of the patients. The T(2) technique represents an auspicious alternative to standard open microsurgery for LLDH, which allows achievement of excellent clinical and cosmetic results, preservation of segmental spine stability, and avoidance of excessive soft tissue trauma.