Preservation Of Roots Research Articles

Type A acute aortic dissection with ≥40-mm aortic root: results of conservative and replacement strategies at long-term follow-up.

We evaluated the long-term results of aortic root (AR) preservation and replacement in patients operated on for acute type A aortic dissection. Out of 302 patients discharged after repair of acute aortic dissection (1977-2019), 124 patients had an AR ≥40 mm, which was preserved in 84 (68%, group A) patients and replaced in 40 (32%, group B) patients. Group B patients were younger (mean age 57 ± 12 vs 62 ± 11 years, P = 0.07), with a mean AR of 47 vs 43 mm and ≥moderate aortic insufficiency in 65% vs 30%. Survival, causes of death and reoperations were analysed at mean follow-up of 9 ± 8 years (6 months to 40 years). Actuarial survival of discharged patients at 5, 10 and 15 years was 97% (0.89-0.99), 78% (0.67-0.90) and 75% (0.64-0.88) in group A, and 85% (0.71-0.95), 62% (0.44-0.78) and 57% (0.39-0.76) in group B (log-rank test P = 0.2). Nine patients in group A (7 patients for aortic insufficiency and dilatation of the root and 2 patients for pseudoaneurysm) and 1 patient of group B (pseudoaneurysm of the right coronary button) required proximal reoperation without deaths. At 5, 10 and 15 years, the cumulative incidence of proximal aortic reoperations was 5%, 9% and 25% in group A, and 0%, 3% and 3% in group B (P = 0.02). At multivariable analysis AR >45 mm [hazard ratio (HR) 6.8, P = 0.026] and age (HR 0.9, P = 0.016) were independently associated with proximal reoperation. AR preservation in acute type A dissection showed acceptable long-term outcomes. Nevertheless, a more aggressive approach appears a valid option, especially in patients with AR diameter >45 mm.

Digital workflow of orthodontic and prosthetic treatment for subgingival residual root preservation guided by target restoration space

The use of orthodontic traction to preserve healthy subgingival residual root is a classical method combining the treatment of restoration and orthodontics. Based on the target restoration space (TRS), by establishing a TRS digital model, the final traction position of the subgingival residual root can be preset. After evaluating the key parameters such as crown-to-root ratio and minimum crown height, clinicians can estimate the treatment time and exclude cases with bad preset position. The time of traction treatment can be effectively reduced, and the efficiency and efficacy of the entire treatment can also be improved.

Does adding a root replacement in type A aortic dissection repair provide better outcomes?

Acute type A aortic dissection (ATAAD), is a surgical emergency often requiring intervention on the aortic root. There is much controversy regarding root management; aggressively pursuing a root replacement, versus more conservative approaches to preserve native structures. Electronic database search we performed through PubMed, Embase, SCOPUS, google scholar, and Cochrane identifying studies that reported on outcomes of surgical repair of ATAAD through either root preservation or replacement. The identified articles focused on short- and long-term mortalities, and rates of reoperation on the aortic root. There remains controversy on replacing or preserving aortic root in ATAAD. Current evidence supports practice of both trends following an extensive decision-making framework, with conflicting series suggesting favorable results with both procedures as the approach that best defines higher survival rates and lower perioperative complications. Yet, the decision to perform either approach remains surgeon decision and bound to the extent of the dissection and tear entries in strong correlation with status of the aortic valve and involvement of coronaries in the dissection. There exists much controversy regarding fate of the aortic root in ATAAD. There are conflicting studies for impact of root replacement on mortality, whilst some study's report no significant results at all. There is strong evidence regarding risk of reoperation being greater when root is not replaced. Majority of these studies are limited by the single centered, retrospective nature of these small sample sized cohorts, further hindered by potential of treatment bias.

Fabrication of tooth supported overdenture using customized metal short copings: A case report

Overdenture has been a proven mainstay of conservative prosthodontic treatment when proper diagnosis, treatment planning, and most importantly, patient compliance are achieved. Despite recent developments in dental implantology, the conservative approach to root preservation followed by an overdenture is still valid. The many advantages of root retention include- alveolar bone maintenance, better prosthesis support, proprioceptive feedback, aesthetics and psychological benefits. This paper presents a case report of rehabilitation of an edentulous patient with a tooth supported overdenture. Keywords: Short copings, Tooth supported, Overdenture.

Recurrent aortic insufficiency after emergency surgery for acute type A aortic dissection with aortic root preservation

ObjectivePatients with acute type A aortic dissection demonstrate a wide range of aortic insufficiency. Outcomes after valve resuspension and root repair are not well studied in the long term. We evaluated the long-term effects of preoperative aortic insufficiency in patients undergoing emergency root-preserving surgery for acute type A aortic dissection. MethodsFrom 2002 to 2017, 558 of 776 patients with acute type A aortic dissection underwent native aortic valve resuspension and root reconstruction. Patients were stratified into 4 groups by preoperative aortic insufficiency grade (n = 539): aortic insufficiency less than 2+ (n = 348), aortic insufficiency = 2+ (n = 72), aortic insufficiency = 3+ (n = 49), and aortic insufficiency = 4+ (n = 70). Multivariable ordinal longitudinal mixed effects and multi-state transition models were used to assess risk factors for recurrent aortic insufficiency. ResultsThe prevalence of cardiogenic shock in patients presenting with preoperative aortic insufficiency less than 2+, 2+, 3+, and 4+ was 53 of 348 (15.2%), 12 of 72 (16.7%), 10 of 49 (20.4%), and 24 of 70 (34.3%), respectively (P = .002). Postoperatively, 94.0% of patients had aortic insufficiency 1+ or less at discharge. Operative mortality was 34 of 348 (9.8%), 10 of 72 (13.9%), 6 of 49 (12.2%), and 12 of 70 (17.1%) (P = .303). In an ordinal mixed effects model, preoperative aortic insufficiency was associated with more severe postoperative aortic insufficiency. The multi-state transition model demonstrated that severe aortic insufficiency was associated with progression from no to mild aortic insufficiency (hazard ratio, 2.14; 95% confidence interval, 1.35-3.38), and progression from mild to moderate aortic insufficiency (hazard ratio, 5.70; 95% confidence interval, 1.88-17.30). ConclusionsPreoperative aortic insufficiency is an important predictor of recurrent aortic insufficiency in patients undergoing valve resuspension with root reconstruction for emergency acute type A aortic dissection repair. Increased echocardiographic surveillance for recurrent aortic insufficiency may be warranted in this cohort.

Strain and retrogression partitioning explain long-term stability of crustal roots in stable continents

Abstract Away from tectonically active regions, the continental crust has an average thickness of 40 ± 1 km. Yet, it shows a remarkable variability from 25 to 65 km, comparable to that of the most tectonically active regions. Here, we consider the problem of the formation and preservation of anomalous deep crustal roots in stable intracontinental regions. Using two-dimensional thermomechanical experiments, we show that the interplay between partial melting, the formation of garnet-pyroxene-bearing rocks, and their strain rate–dependent retrogression result in the preservation of thick and strong crustal roots. We argue that it is the partitioning into narrow regions of strain, retrogression, and weakening coupled into a positive feedback loop that explains why strong high-grade crustal roots remain largely immune to gravitational stresses and are able to persist over hundreds of millions of years.

ВЛИЯНИЕ РЕЖИМОВ РАБОТЫ ВЫКОПОЧНОЙ МАШИНЫ НА КАЧЕСТВО ВЫКОПКИ ПОСАДОЧНОГО МАТЕРИАЛА

One of the important indicators of the quality of planting material grown in forest nurseries is preservation of roots and the amount of soil remaining on the root system of plants when they are excavated. Machines used in forest nurseries for digging planting material do not fully meet these requirements, since soil layer is not sufficiently loosened and soil is not separated from the root systems of plants. In addition, considerable effort is required to extract plants from the soil, and part of the roots is cut off. Modern plant lifters with active working bodies enable to separate the soil from the root systems of plants and ensure safety of the required amount on them, reducing the effort to extract plants from the soil. The article presents the results of studies of the influence of plant lifter operating modes on the quality of planting material harvesting, on the basis of which the rational oscillation frequency of the levers and beats within 675 counts/min is substantiated when applying one oscillation of 5.4 cm/count and operating speed 2.2 km/h. These operation modes of plant lifter ensure the preservation of soil on the root system of enlarged spruce seedlings in the amount of 136.2 g and allowable effort to remove them from the soil within 36.4 N.

Terminology and Localization: How Terminological Units Are Russified during Translation

Abstract—This paper considers the problem of terminology localization during translation. The author introduces the notions of russification (nostrification) and preservation of the foreign root in a borrowed term (alienization), which help to explain the extent to which a translation assimilates a foreign language text and its units in the target language and the extent to which a translation indicates the differences in these texts. The author argues that the basic rule of localization, that is, conversion of global text units into local text units that comply with the local language norms, is of a relative character and is dependent on the field the source (global) text belongs to.

Bar Attachement Retained Mandibular Complete Denture: A Case Report

The mandibular complete denture is a challenge for the dentist. Unfavorable anatomical and physiological conditions such low bearing surface and a significant bone resorption, often compromise the prosthetic retention.The exploitation of root stumps is a reliable alternative that leads to a better prosthetic integration by increasing the retention, if the total prosthesis is connected to these root stumps via axial ball or bar attachments.In addition, this prosthetic alternative considerably improves the patient's comfort and masticatory coefficient and favors the preservation of the bone capital, provided that the requirements of root preservation as well as clinical and laboratory techniques are respected.We would like to illustrate this by presenting a clinical case in which we used the connecting bar in the mandibular arch.

One-Step Reconstruction with a Novel Suspended, Modular, and 3D-Printed Total Sacral Implant Resection of Sacral Giant Cell Tumor with Preservation of Bilateral S1-3 Nerve Roots via a Posterior-Only Approach.

ObjectiveTo investigate the efficacy and safety of spinopelvic reconstruction based on a novel suspended, modular, and 3D‐printed total sacral implant after total piecemeal resection of a sacral giant cell tumor (SGCT) with the preservation of bilateral S1–3 nerve roots via a posterior‐only approach.MethodsFive patients who had undergone total piecemeal resection of SGCT involving upper sacral segments (S1 and S2) and the midline with the preservation of bilateral S1–3 nerve roots via a posterior‐only approach between September 2017 and July 2018 were retrospectively reviewed. A novel suspended, modular, and 3D‐printed total sacral implant had been used for reconstruction. This series included two female and three male patients, with a mean age of 42.2 years (range, 31–53 years). Surgical time, blood loss, complications, preoperative and postoperative neurological function, instrumentation failure, and local control were presented and analyzed.ResultsAll patients underwent the operation without death or serious complications. The implant was installed on the defect, connecting the ilium and lumbar vertebrae, and fixed with a screw–rod system up to the level of L3–4 or L4–5. The mean operative time was 502 min (range, 360–640 min) and the mean operative blood loss 4400 mL (range, 3000–7000 mL). The mean follow‐up was 15 months. After the operation, pain was significantly relieved, and the patients resumed walking as early as 2 weeks later. The patients showed no neurogenic bladder dysfunction and no fecal incontinence or gait disturbance. Wound healing was poor in one patient. Patients recovered well without evidence of local recurrence. No implant failures or related clinical symptoms were detected during follow up. Satisfactory bone ingrowth and osseointegration at the bone‐implant junctions was found in follow‐up CT.ConclusionAlthough technically challenging, it is feasible and safe to use a suspended, modular, and 3D‐printed implant for reconstruction after total piecemeal resection with the preservation of bilateral S1–3 nerve roots in patients with SGCT. We believe that this implant can be applied to sacral reconstruction in a wide variety of diseases.

Computed Tomography−Guided Posterolateral Transsacral Ala Approach to Presacral L5 Schwannoma: Technical Note

Presacral schwannomas are rare benign tumors that may reach large size before becoming symptomatic. Total surgical removal has been considered the best treatment option. Tumors arising from the presacral area are commonly managed through anterior approaches, whereas posterior approaches are used for pure intrasacral tumors or large lesions with both intrasacral and presacral extension, alone or in combination with anterior approaches. We describe a quick and minimally invasive navigation-guided posterolateral approach to a right presacral L5 schwannoma. The lesion was microsurgically removed through high-speed drilling of the upper portion of the right sacral ala, under intraoperative neurophysiologic monitoring. The postoperative course was unremarkable, and the patient experienced improvement in his sensory disturbance. Postoperative magnetic resonance imaging and computed tomography scan showed the complete excision of the lesion and the removal of the upper sacral ala with preservation of the right L5-S1 articular complex. The histologic examination confirmed a schwannoma (World Health Organization grade I). The posterolateral transsacral ala approach may represent a minimally invasive option in the surgical management of presacral well-circumscribed benign tumors. Spinal navigation could be properly used to facilitate lesion exposure and to minimize the bone removal. The intraoperative neurophysiologic monitoring is an essential tool for the preservation of the lumbosacral nerve roots.

Obstructive sleep apnea secondary to cervical spine chordoma

Abstract We present a rare case of obstructive sleep apnea (OSA) secondary to chordoma involving cervical spine with confirmative histopathological diagnosis following the suggestive findings of computed tomography and magnetic resonance imaging. The patient underwent en bloc removal of the tumour involving the vertebral body of C4 with preservation of the nerve roots and vertebral arteries involved, associated with postoperative radiation therapy. Clinicians should be aware that this is a very rare secondary cause of OSA caused by chordoma involving the spine and imaging of the cervical spine may be necessary to avoid incorrect treatment approaches such as CPAP or BiPAP machine in such cases.

Distribution and Preservation of Root‐ and Shoot‐Derived Carbon Components in Soils Across the Chinese‐Mongolian Grasslands

AbstractThe relative contribution of roots versus shoots to soil organic carbon (SOC) is a long‐debated topic related to soil carbon formation and dynamics. However, the variation of root‐ and shoot‐derived carbon in natural soils remains poorly constrained due to limited tools to separate them. Here we overcome the difficulty by analyzing biomarkers for root (suberin) and shoot (cutin) in grassland soils spanning >7,000 km on the Qinghai‐Tibetan and Mongolian Plateaus. Coupled with a comprehensive list of climatic, edaphic, and vegetation variables, we assess their inputs, distribution, and preservation patterns. We find that while suberin was a root‐specific tracer, cutin biomarkers that occurred only in trace amount in roots also had a minor but nonnegligible contribution from belowground sources due to the massive root mass in the alpine grasslands. Both components had higher SOC‐normalized concentrations in the alpine than temperate grasslands, along with a higher preservation percentage against net primary productivity and a lower degradation parameter, suggesting a better preservation of these plant‐derived lipid components in the alpine region. Moreover, while cutin and suberin abundances were affected by plant inputs and other SOC constituents, the root mass normalized incorporation efficiency of suberin was only positively correlated to SOC in both regions with a steeper slope in the alpine grasslands and also negatively correlated to root mass in the alpine soils. These results imply that root carbon incorporation is sensitive to environmental variations in the cold region, suggesting potentially more dynamic alterations to root carbon sequestration with environmental changes.

STUDY OF THE INFLUENCE OF THE RIPENESS DEGREE OF PARSNIP ROOTS AND STORAGE METHOD ON THEIR PRESERVATION

Sowing parsnip is recommended to be harvested in the stage of technical ripeness that takes place in 120–150 days after sprouts. A ripeness degree cannot be determined by a root size, because in this case planting conditions and agrotechnique play an important role. The aim of the research was to analyze the influence of a vegetation period duration of different sorts of sowing parsnip on formation of chemical composition components and roots preservation to determine the dependence between the content of dry soluble substances and one of dry substances, sugars, saccharose, reducing sugars, ascorbic acid. The research gives a possibility to get roots with the maximal content of chemical composition components and long storage period. There has been studied the influence of a vegetation period duration of different sorts of sowing parsnip on formation of chemical composition components and roots preservation. The dependence between the content of dry soluble substances and one of dry substances, sugars, saccharose, reducing sugars, ascorbic acid has been determined. The research has been conducted with parsnip roots of sowing sort Petrik, Student, Boris. There has been studied the influence of a ripeness degree (vegetation period duration) on a quality and preservation of parsnip roots. Parsnip roots of the sowing sorts Student and Boris are characterized by the most content of the dry substance 27,1–25,4 %, and content of the total sugar 5,7–5,4 %, high content of vitamin С 10,2–10,1 mg/100 g. It has been established, that the studied sorts are not inclined to nitrates accumulation, their content varies from 60 to 80 mg/kg and is lower than the maximally permitted level (MPL 250 mg/kg). There has been established the direct strong connection between the content of the dry substance and sugars content (r=0,98), nitrates content (r=0,80) and the middle content with the testing mark (r=–0,54) and vitamin С (r=0,57). The dry soluble substance content has the direct strong connection with the sugars content (r=0,99), nitrates content (r=0,78) and middle connection with the content of vitamin С (r=0,46) and reverse middle connection with the testing mark (r=–0,52). The reverse middle connection exists between the sugars content and the testing mark (r=–0,52) and the direct strong connection with nitrates content (r=0,84), middle connection with the content of vitamin C (r=0,48). At storage of roots the loss of the mass of dry substances is from 11,5 % at storage in an open box to 6,2 – in a polyethylene film. The most changes take place in saccharose and monosaccharides, 36,6 and 33,0 % respectively. The content of vitamin C decreases by 30 % at storage in an open box and by 10 % in a polyethylene film. The vegetation period duration as 150 days is characterized by the lower sugars content, but at that the ratio saccharose: monosacharides – the most. There has been offered the method of determining the ripeness degree of parsnip roots by the saccharose content. At the technical ripeness the amount of saccharose is 72–75 % of the total amount of sugars. The optimal ripeness is characterized by deceleration of growing processes, decrease of saccharose accumulation rates, the most ratio of the roots mass to the one of leaves and saccharose to monosugars. The method of roots storage with p. e. film decreases losses of nutrients of roots and increases the storage duration.

The state of coenopopulations of the vegetatively-semimobile species of Thymus in Southern Siberia

The state of coenopopulations of vegetatively-semimobile dwarf shrubs Thymus iljinii, T. minussinensis, T. mongoliens, T. petraeus, widely distributed in steppe communities in Southern Siberia was studied. Adults of the species are a clump consisting of a primary and several partial bushes. For individuals characterized by the preservation of the main root, weak vegetative growth and reproduction, slow seizure of territory. The complex of data on organizational and population characteristics is analyzed. It is established that the real optimum state of coenopopulations of the studied species is achieved in the petrophytic variants of steppes located on the slopes of mountains. Conditions of highmountain steppe and alpine plant communities are unfavorable for Thymus.

Corrected Transposition: Anatomic Repair Using the Hemi-Mustard Atrial Baffle and Bidirectional Superior Cavopulmonary Connection.

Anatomic repair for congenitally corrected transposition requires thoughtful surgical planning at both initial (neonatal or late) presentation, and during definitive repair. An algorithmic approach to the overall management of this lesion, with its many associated intracardiac anomalies, is presented. Modified atrial switch with bidirectional superior cavopulmonary connection is commonly utilized and demonstrates favorable results through a 20-year experience. Herein, technical considerations learned during the implementation of this strategy are described and emphasize the concept, in selected cases, of native pulmonary root preservation by translocation as an adjunct that is uniquely suited by adopting this approach.

Ascending Aorta Aneurysm: What is the Risk of Replacing the Aortic Root?

Background: In mildly dilated aortic root, the cost-benefit of replacing of the sinuses of Valsalva with reimplantation of thecoronary arteries or preserving them is still a matter of debate.Objective: The goal of this study was to analyze the postoperative and long-term morbidity and mortality of patients undergoingaortic root replacement versus aortic root surgery with sinuses of Valsalva preservation.Methods: Between 2002 and 2016, 426 patients underwent replacement of the ascending aorta. After excluding patients undergoingurgent procedures, genetic aortic diseases (except for bicuspid aortic valve), reoperations and surgery of the aortic arch,the cohort was made up of 259 patients. In 99 of them (38.2%) the ascending aorta was replaced, preserving the aortic root;these patients were compared with the remaining 160 (61.8%) patients who underwent replacement of the sinuses of Valsalva.Results: Patients undergoing preservation of the aortic root were older, had higher percentage of female sex, higher EuroSCOREand with greater incidence of bicuspid aortic valve and coronary artery disease. Cardiopulmonary bypass time was longer inthe group undergoing aortic root replacement. There were no significant differences in in-hospital mortality between bothgroups (1% in the group with preservation of the aortic root vs. 3.1% for replacement of the sinuses of Valsalva, p=0.272).Multivariate analysis showed that cardiopulmonary bypass was a predictor of in-hospital mortality. Survival at 8 years wassimilar in both groups. There were no new operations due to complications in the aorta during follow-up. At multivariateanalysis, age and mitral valve disease were identified as predictors of long-term mortality.Conclusion: Replacement of the ascending aorta, either replacing the aortic root or preserving the sinuses of Valsalva, is asafe procedure, with low in-hospital mortality. Preservation of the sinuses of Valsalva is not associated with greater rate ofevents or mortality at the long-term.

Pros and Cons of C2 Nerve Sectioning/Preservation in Posterior Fusion for Congenital Atlantoaxial Dislocation

Deliberate C2 nerve root sectioning and its preservation have been described during posterior fusion for atlantoaxial dislocation (AAD). However, the associated outcomes have been less studied, especially in congenital AAD. Our objective was to study the clinical outcomes after C2 nerve root sectioning and the feasibility of C2 preservation in these patients. The data from 190 patients were retrospectively studied. The decision to cut or preserve the C2 nerve root was determined by the preoperative radiologic findings and intraoperative suitability of its preservation. During follow-up, the patients were questioned about C2 nerve-related dysfunction. The pros and cons of sectioning or preservation of the C2 nerve root and the related feasibility factors are also described. Complex C1-C2 anatomy that required extensive dissection and drilling was seen in 139 patients. After C2 nerve root sectioning in 178 patients, none reported bothersome hypoesthesia, paresthesia, or dysesthesia that required medication. However, 9 patients (5.1%) developed nonhealing occipital ulcers and most required flap coverage or a skin graft. C2 nerve root preservation is feasible with an adequate inferior C1 lateral mass and normal-size ganglion. In patients with C1-occipital condyle hypoplasia, extremely oblique joints, spondyloptosis, incurved occiput, pseudofacets, and anomalous vertebral artery, preservation of the C2 nerve root is difficult. The advantages of sectioning the C2 nerve root are many. However, a subset of patients is prone to morbid occipital neuropathic ulcers. After C2 nerve sectioning, one should be cautious of such complications. C2 nerve root preservation should be strongly considered for patients with favorable anatomy.

Giant Cell Tumor of the Sacrum: Series of 19 Patients and Review of the Literature.

There are still some debates regarding the best treatment of Giant Cell Tumor (GCT) of the sacrum. Since GCT of this location is rare, therapeutic strategies are mainly based on the treatment of GCT in other anatomic locations. The objective of this study was to evaluate the oncologic and clinical results of surgical management of sacral GCT with and without local adjuvant therapy. Medical records of 19 patients diagnosed with GCT of the sacrum, were retrospectively reviewed. Sixteen patients were treated by intralesional curettage and three patients with marginal resection. Musculoskeletal tumor society (MSTS) score was used for the evaluation of functional outcome. Prolonged pain was the most common complication after treatment. Mean Pre and post-operative pain based on visual analogue scale (VAS) was 6.1 ± 1.99 and 3.05 ± 1.64, respectively. Postoperative neurologic deficit appeared in six patients. In addition, infection occurred in five patients. One case of spinopelvic instability was also observed after surgery. At average follow up of 158.5 ± 95.9 months (25 to 316 months), recurrence was seen in eight (42.7%) out of seventeen patients treated by intralesional curettage. The size of the tumor significantly correlated with the tumor recurrence (r=0.654, P=0.001). Mean MSTS score was 74.7 ± 16.78. Those patients, in whom sacral nerve roots remained intact before and after surgery, had better functional outcome. Preservation of sacral nerve roots is associated with better functional outcome and less pain. Although an acceptable surgical outcome was observed in our cohort, the problem of local recurrence still warrants further investigations for better local control of the tumor.

Surgical treatment of intraforaminal/extraforaminal lumbar disc herniations: Many approaches for few surgical routes.

Several disc disease nomenclatures and approaches for LDH exist. The traditional midline bone-destructive procedures together with approaches requiring extreme muscular retraction are being replaced by muscle sparing, targeted, stability-preserving surgical routes. The increasing speculation on LDHs and the innovative corridors described to treat them have lead to an extensive production of papers frequently treating the same topic but adopting different terminologies and reporting contradictory results. The review of such literature somehow confounding gave us the chance to regroup by surgical corridors the vast amount of approaches for LDH differently renamed over time. Likewise, LDHs were simplified in intra-foraminal (ILDH), extra-foraminal (ELDH), and intra-/extra-foraminal (IELDH) in relation to precise anatomical boundaries and extent of bulging disc. Through the analysis of the papers, it was possible to identify ideal surgical corridors for ILDHs, ELDHs, and IELDHs, distinguishing for each approach the exposure provided and the technical advantages/disadvantages in terms of muscle trauma, biomechanical stability, and nerve root preservation. A significant disproportion was noted between studies discussing traditional midline approaches or variants of the posterolateral route and those investigating pros and cons of simple or combined alternative corridors. Although rarely discussed, these latter represent valuable strategies particularly for the challenging IELDHs, thanks to the optimal compromise between herniation exposure and bone-muscle preservation. The integration of adequate mastery of traditional approaches together with a greater confidence through unfamiliar surgical corridors can improve the development of combined mini-invasive procedures, which seem promising for future targeted LDH excisions.