Extreme Lateral Lumbar Disc Herniations Research Articles

The long-term clinical results of microendscopic discectomy for extreme lateral lumbar disc herniation

The long-term clinical results of microendscopic discectomy for extreme lateral lumbar disc herniation

Early clinical results of channel-assisted combined fixation and interbody fusion for treating lumbar vertebra diseases by muscle-splitting approach

Objective To explore the feasibility and effectiveness of channel-assisted spatium intermusculare approach interbody fusion for treating lumbar vertebra diseases. Methods A total of 81 patients with lumbar vertebra diseases were treated from June 2012 to December 2013, including 35 males and 46 females between 29 and 76 years old with an average age of 54.6. There were 36 cases of lumbar disc degeneration, 10 cases of recurrence in situ after lumbar disc herniation surgery, 6 cases of huge lumbar disc herniation, 11 cases of lumbar disc herniation with spinal canal stenosis, 5 cases of extreme lateral lumbar disc herniation and 13 cases of lumbar degenerative spondylolisthesis. There were 67 cases of single segment lesion and 14 cases of two segment lesions. Lesion sites contained L1, 2 in 1 case, L3, 4 in 4 cases, L4, 5 in 50 cases, L5S1 in 12 cases, L3, 4 and L4, 5 in 8 cases, and L4, 5 and L5S1 in 6 cases. Results The length of incision was 2.42±0.45 cm in cases of single segment lesion and 4.28±0.38 cm in cases of two segment lesions. The operation time was 96.00±21.53 minutes and intraoperative blood loss was 347.50±241.62 ml. During the operation, one case suffered from dural laceration, cerebrospinal fluid leakage and ipsilateral nerve root injury. Two cases suffered from pedicle fractures. Eight cases experienced epidermal necrosis of the incision. One case had poor wound healing. Three cases suffered from nerve injury. A total of 76 patients were followed up for 12-30 months, averagely 20.5 months. Intervertebral height of lesion segments was apparently recovered after surgery, and maintained in good condition during the final follow-up. No significant difference in the changes of area and grade of multifidus was detected 12 months after surgery and before surgery. Except 4 cases, the remaining had interbody fusion with a fusion rate of 94.7%. The balance between the coronal plane and sagittal plane of the lumbar spine was evidently improved. Average Japanese Orthopaedic Association score increased from 12.66±1.88 points preoperatively to 26.4±1.92 points during the final follow-up, which showed significant differences. Conclusion The method of channel-assisted spatium intermusculare approach interbody fusion has some advantages for treating lumbar vertebra such as small incision, fewer traumas, less bleeding, fast recovery, and high fusion rate. However, there is a long time of operation in the early stage and high occurrence rate of complications. Key words: Lumbar vertebrae; Bone screws; Zygapophyseal joint; Spinal fusion

경피적 내시경 수핵제거술 후 운동유형이 체간근력 및 요통지수에 미치는 영향

This study looked at the effects on the trunk muscle strength and the oswestry disability index(ODI) of modes of waist-hip exercise (static stability, dynamic stability, weight), after a patient was operated by percutaneous endoscopic discectomy. Furthermore, this study was implemented to provide necessary supporting data for designing a desirable future rehabilitation and exercise program for the patient with the percutaneous endoscopic discectomy, reaching the conclusions as below. 1. Trunk Muscle Strength As for the changes in trunk muscle strength by angle when measuring with the Centaur, the differences between periods per group have shown that all the three groups - static stability exercise, dynamic stability exercise and weight exercise - the trunk muscle strength on both sides increased more significantly (p.001) after exercise than before exercise, while no significant differences were present between groups per period. 2. The Oswestry Disability Index(ODI) In the differences between periods per group, all the three groups - static stability exercise, dynamic stability exercise and weight exercise - turned out to show reduction, 4, 8 and 12 weeks after exercise, more significantly (p.001) than before exercise. In the differences between groups per period, on the other hand, the weight exercise group released a significantly lower figure(p.05) 12 weeks after exercise than both groups of static and dynamic stability exercise. As examined above, different exercise programs were implemented separately, which consequently showed that, after the percutaneous endoscopic discectomy applied to a patient with extreme lateral lumbar disc herniation, those programs - the static, dynamic stability exercise and the weight exercise program - had positive effects on DITI-based trunk muscle strength the passage of time. However, this study failed to provide the most effective exercise mode among the programs by exercise mode. Therefore, we see it necessary to apply continuing, systematic and objective exercise programs, and to add the realization of data standardization to use as objective clinical data, by designing multiple methods of measurement for the patients related.

Extreme lateral lumbar disc herniation in a 12-year child: case report and review of the literature

Extreme lateral lumbar disc herniations (ELLDHs) occur more frequently among elderly patients, with a peak incidence in the sixth decade, and are rarely found in children. The patient presented is a 12-year-old boy with a 3-month history of right-sided leg pain. Computerized tomography and magnetic resonance imaging demonstrated an extreme lateral disc herniation on the right at L4-L5 with compression of the L4 nerve root. He subsequently underwent removal of extreme lateral herniated disc through an intertransverse approach under general anesthesia. At 11-month follow-up, the patient maintained resolution of preoperative symptoms and a neurological examination revealed no sensory or motor deficit. Surgical intervention may be indicated for patients with ELLDHs that fail with conservative treatment.

Clinical Results and Surgical Technique for the Treatment of Extreme Lateral Lumbar Disc Herniations: The Minimally Invasive Microscopically Assisted Percutaneous Approach

Operative techniques for the treatment of extreme lateral lumbar disc herniations (ELLDH) have ranged from an interlaminar approach with subtotal or total facetectomy to an enlarged midline approach and various paraspinal lateral, as well as endoscopic approaches. In contrast to purely endoscopic techniques, use of a working tube together with an operative microscope ("minimally invasive microscopically assisted percutaneous approach") combines the advantages of three-dimensional visual control with the minimal surgical trauma of an endoscopic approach. We present this technique and the clinical results in patients with extreme lateral lumbar disc herniation (ELLDH). In a retrospective case series we analyzed the data of 73 consecutive patients with a disc herniation within or lateral to the intervertebral foramen. All of them were operated on using the surgical microscope after blunt dilatation of the paraspinal muscles and insertion of a tubular retractor system (METRx, Medtronic Sofamor Danek). Fifty-nine patients were included in the follow-up study. Follow-up ranged from 10 to 47 months (mean 30.4) and was evaluated after telephone inquiry by the co-author using the modified MacNab criteria . The results with respect to improvement of preoperative symptoms were excellent in 23 patients (39%), good in 25 patients (42.4%), fair in 8 patients (13.5%) and poor in 3 patients (5.1%). Twenty-four patients had still been working prior to surgery, and 20 returned to work after 4-8 weeks. The paraspinal approach for extreme lateral lumbar disc herniations using the minimally invasive microscopically assisted percutaneous technique is reasonable and safe and thus a good alternative to open surgical procedures.

Study on surgical treatment of extreme lateral lumbar disc herniation

Study on surgical treatment of extreme lateral lumbar disc herniation

V-5-74 - Extreme-lateral lumbar disc herniation: A comparison of surgical techniques

V-5-74 - Extreme-lateral lumbar disc herniation: A comparison of surgical techniques

The far lateral approach to lumbar disc herniations.

The diagnosis of extreme lateral lumbar disc herniation (ELLDH) as a cause of lumbar radiculopathy was first described by Abdullah in 1974 [1]. This discal pathology has been recognized for many years as an occasional cause of negative disc exploration and immediate failure of classical disc surgery in sciatica [1,18, 24, 25, 29, 31, 30, 31, 33, 35, 41]. Only since the introduction of computed tomography (CT) for the diagnosis of lumbar disc disease have the characteristics of ELLDH become fully appreciated [3, 6,13,17,23, 30,32,47]. Myelography alone was an insufficient diagnos- tic tool to detect this specific pathology. With the rapid development of neuroradiologic diagnostic imaging, including magnetic resonance imaging (MRI) [13, 32], recognition of this particular type of lumbar disc disease has increased its incidence, ranging from 0.7% to 11.7% of the total operated herniated discs [1, 22, 24, 45]. In a recent review of our series of patients with lumbar disc disease we found an overall incidence of ELLDH of 5.8% over a period of 8 years [38]. 78% of all ELLDH occured at the L4-L5 and L5-S1 levels, with an almost equal frequency, but the overall incidence of ELLDH per level varied relative to the level of the pathological disc.

最外側突出型腰椎椎間板ヘルニアにおける診断上の問題点およびその治療について

最外側突出型腰椎椎間板ヘルニアにおける診断上の問題点およびその治療について

Microsurgical anatomy and operative technique for extreme lateral lumbar disc herniations.

The anatomy of the lateral aspect of the lumbar spine and our lateral microsurgical technique for extreme lateral lumbar disc herniations (ELLDH) is described. This study was based on the microdissection of 4 cadavers, on the morphometric evaluation of these as well as 6 dried cadaver spines and 8 lumbar CT scans, and on the use of this technique on over 200 cases. Level dependent changes in the posterior arch cause a shift of the disc space distally relative to the facet joint, an increasing amount of bone to overlie the intervertebral foramen, and a decreasing amount of working space within the exposure in the caudal direction. Therefore, more bone removal from the lateral aspect of the pars interarticularis and supero-lateral aspect of the facet joint is required in the lower lumbar spine. When the exposed ligamentum flavum is resected, the dorsal root ganglion is seen and access to the herniation and disc space is achieved. Level dependent changes in the pedicles and transverse processes lead to an alteration in the course and relationships of the nerves, thereby influencing the pathophysiology of and surgical technique for the ELLDH. The operative target is the lateral aspect of the pars interarticularis and not the intertransverse space as has been previously described. Our techniques allows for the early identification of the nerve with minimal risks of injury to it, to the adjacent vessels and to the structural integrity of the facet joint and pars interarticularis.

Diagnosis and Operative Treatment of Intraforaminal and Extraforaminal Nerve Root Compression

The clinical, radiologic, and operative findings, and clinical results in 26 cases of foraminal nerve root involvement, each treated by variable operative procedures for an existing pathologic condition, were studied. These 26 cases consisted of 8 intraforaminal or extraforaminal lumbar disc herniations and 18 foraminal nerve root entrapments. The cases with an extreme lateral lumbar disc herniation underwent lateral fenestration or osteoplastic hemilaminectomy without concomitant spinal fusion, and showed excellent operative results. A sufficient selective decompression was achieved with a good clinical result in the cases of lumbar spondylosis without preoperative spinal instability, by lateral fenestration or osteoplastic hemilaminectomy. This result suggests that the selective decompression procedure is recommended for cases with reliable preoperative diagnoses. When an intraspinal lesion makes it difficult to diagnose coexisting foraminal nerve root involvement, decompression of the nerve root canal, approaching from medial to lateral, is recommended. The fusion operation should be performed in cases undergoing even a unilateral total facetectomy, regardless of the patient's old age. A correct preoperative diagnosis is crucial in order to obtain satisfactory operative results.

Surgical management of extreme lateral lumbar disc herniations: review of 138 cases.

Extreme lateral disc herniations in the authors' series account for 10% of all lumbar herniations; 80% occurred at the L3, L4 and L4, L5 interspaces. The authors review the clinical findings in 138 patients and point to the characteristic features of the clinical syndrome. They compare the accuracy of various diagnostic studies and conclude that computed tomography is highly accurate and should be used before other diagnostic studies. Discography is still helpful as a confirmatory study in some cases, whereas myelography is particularly useful in disclosing other associated lesions. Analysis of the operative series revealed a high percentage of extruded fragments (60%) and a significant number of double herniations on the same side and at the same level (15%). These two findings may respectively preclude chemonucleolysis and microsurgery from the surgical management of extreme lateral herniations. Double herniations explain some discrepancies in the clinical picture and are emphasized as a potential source of error in diagnosis. The surgical technique allows exploration for herniations within the intervertebral canal as well as for extraforaminal herniations without sacrifice of the facet. Operative results are presented.

Surgical management of extreme lateral lumbar disc herniations

Surgical management of extreme lateral lumbar disc herniations

Extreme lateral lumbar disc herniation.

Extreme lateral lumbar disc herniation (ELLDH) occurring into and/or outside the intervertebral foramen was encountered in 95 cases amongst 1600 operations for herniated lumbar disc (6%): 43% occurred at L5-S1, 38% at L4-5, 18% at L3-4, and 1% at L2-3. The incidence amongst all herniations at one particular level was 6% at L5-S1, 4% at L4-5, and 18% at L3-4. The clinical presentation varied according to the level of extreme lateral disc herniation, but was not different from the presentation of a classical paramedian herniation occurring one level above. Forty-three patients were investigated with computed tomography (CT) only, 2 with myelography only, and 50 with both. CT always clearly demonstrated the pathology, but some cases are presented to illustrate the differential diagnosis. Myelography was normal in 13 cases; in 27 cases it showed a typical shortening and enlargement of the nerve root sheath which enters the affected intervertebral foramen. At operation, a total facetectomy was performed in 52 patients, a partial facetectomy in 34, and a lateral approach to the intervertebral foramen in 9. The lateral approaches, either paramuscular with retraction of the paraspinal muscles from the midline, or transmuscular by splitting of the paraspinal muscles, are described and illustrated in detail.