Posterolateral Foraminal Approach to the Lumbar Disc

Abstract

Foraminal lumbar disc herniations cause an extreme amount of pain due to compression of the dorsal root ganglion and they present a unique problem for surgical excision because of the location volar to the facet joint. The tubular posterolateral approach into the foramen avoids excessive muscle stripping from the midline and avoids significant removal of the facet joint thereby decreasing the need for a potential fusion. The key to the approach is proper positioning of the tubular retractor and a three-dimensional understanding of the spinal anatomy when looking at a limited view of the lateral aspect of the facet joint.