Transtubular Endoscopic Neuronavigation-Assisted Approach for Extraforaminal Lumbar Disk Herniations: A New Trend for a Common Neurosurgical Disease.

Abstract

Extraforaminal lumbar disk herniations (ELDHs) are relatively rare and are, till today, diagnostic and therapeutic challenges. The transmuscular paramedian approach to the extraforaminal space is today the standard surgical approach. Nevertheless, controlling the correct trajectory to the extruded disk fragment continues to represent a challenge. The application of spinal navigation and spinal endoscopy seems to offer great advantages to ELDH treatment. The purpose of this study is to demonstrate the advantages of spinal navigation for ELDHs by taking a purely endoscopic transtubular approach, focusing on technical aspects and clinical outcomes. Nine consecutive patients who underwent a navigation-assisted, muscle-splitting, transtubular, purely endoscopic approach for ELDHs were retrospectively analyzed. Their clinical records were reviewed. Pain evaluations and neurological assessments were conducted. We recorded a notable visual analog scale (VAS) score improvement in postoperative examinations. The mean operation time was 47.05 min. All patients were discharged on postoperative day1. The use of spinal navigation offers a great advantage to ELDH treatment. The aid of navigation allows for a patient-tailored approach and adequate surgical exploration even in face of complex lesion anatomies. The endoscopic transtubular navigated approach seems to offer a significant reduction in operative time, at least in the selected cases.