Treatment of Far Lateral Lumbar disc Herniation Via a Minimally invasive Approach

Yasser Allam,Tarek El-Fiky

doi:10.21608/esj.2012.3785

Abstract

Back Ground Data: Far lateral lumbar disc herniation is a unique entity. It needs special care in designing the best surgical approach. Many limited approached have been advocated. We report a case series treated by a minimally invasive approach. Purpose: to evaluate the efficacy and safety of minimally invasive approach in treatment of far lateral lumbar disc herniation. Study Design: Prospective analytic study. Methods: 25 patients suffering from far lateral disc herniation (extra-foraminal) were operated according to this technique. Through a small skin incision (1.5 cm), the paraspinalmuscles are spread by dilators, until a working channel of 11 mm inner diameter and 14 mm outer diameter can be placed. All further steps are performed through this channel under illumination and control of the operating microscope. The mean follow up period was one year, and patients were evaluated by using the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI). Results: The average surgical time was 49.2 minutes. The ODI improved from 29.96 (preoperative) to 12.12 (post-operative). The VAS of back pain improved from 6.24 (pre-operative) to 3.4 (post-operative).The VAS of leg pain improved from 7.2 (pre-operative) to 2.6 (postoperative). No intra-operative or early postoperative complications occurred. However, only one recurrence happened and could be treated by the same technique. Conclusion: The results from this small series seem to promise that this minimal invasive microscope assisted technique is a practical and valuable alternative to conventional techniques for the treatment of far lateral lumbar disc herniation. The main advantages include: minimal surgical trauma, no effect on the stability of the spine, rapid rehabilitation, short hospital stay and excellent cosmetic outcome. (2012ESJ018)

Highlights

In 1974, Abdullah et al[1] was the first to describe the clinical syndrome of extreme LLDH
25 patients suffering from far lateral disc herniation were operated according to this technique
All further steps are performed through this channel under illumination and control of the operating microscope

Summary

Introduction

In 1974, Abdullah et al[1] was the first to describe the clinical syndrome of extreme LLDH. Intraforaminal, extraforaminal, far-lateral, and extreme lateral are terms that have been used to describe the disc herniation as either into or lateral to the limits of the intervertebral foramen or lateral interpeduncular compartment. This is the space bordered superiorly and inferiorly by the pedicles of the respective vertebrae, and ventrally by the posterolateral portion of the vertebral body and disc space. Both CT and MRI are fairly accurate in showing the pathology[7,15,20,21]. Discography with or without CT has been helpful in equivocal cases[16,17]

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