Abstract
Background: 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.
Objective: 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.
Methods: 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.
Results: 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 day 1.
Conclusion: 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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Pirris SM, Dhall S, Mummaneni PV, Kanter AS. Minimally invasive approach to extraforaminal disc herniations at the lumbosacral junction using an operating microscope: case series and review of the literature. Neurosurg Focus. 2008;25(2):E10. https://doi.org/10.3171/FOC/2008/25/8/E10.
D’Ercole M, Innocenzi G, Ricciardi F, Bistazzoni S. Prognostic value of Michigan State University (MSU) classification for lumbar disc herniation: is it suitable for surgical selection? Int J Spine Surg. 2021;15:466. https://doi.org/10.14444/8068.
Epstein NE. Case presentation and short perspective on management of foraminal/far lateral discs and stenosis. Surg Neurol Int. 2018;9:87. https://doi.org/10.4103/sni.sni_66_18.
Evran S, Katar S. Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations. Ideggyogy Sz. 2021;74:27. https://doi.org/10.18071/isz.74.0027.
Viswanathan R, Swamy NK, Tobler WD, Greiner AL, Keller JT, Dunsker SB. Extraforaminal lumbar disc herniations: microsurgical anatomy and surgical approach. J Neurosurg. 2002;96(2 Suppl):206–11. https://doi.org/10.3171/spi.2002.96.2.0206.
Al-Khawaja DO, Mahasneh T, Li JC. Surgical treatment of far lateral lumbar disc herniation: a safe and simple approach. J Spine Surg. 2016;2:21. https://doi.org/10.21037/jss.2016.01.05.
Ünsal Ü, Senturk S. Minimally invasive far-lateral microdiscectomy: a new retractor for far-lateral lumbar disc surgery. Cureus. 2021;13:e12625. https://doi.org/10.7759/cureus.12625.
Nicoletti GF, Umana GE, Chaurasia B, Ponzo G, Giuffrida M, Vasta G, Tomasi SO, Graziano F, Cicero S, Scalia G. Navigation-assisted extraforaminal lumbar disc microdiscectomy: technical note. J Craniovertebr Junction Spine. 2020;11(4):316–20. https://doi.org/10.4103/jcvjs.JCVJS_146_20.
Yoshikane K, Kikuchi K, Okazaki K. Posterolateral transforaminal full-endoscopic lumbar discectomy for foraminal or extraforaminal lumbar disc herniations. World Neurosurg. 2020;146:e1278–86. https://doi.org/10.1016/j.wneu.2020.11.141.
Liu L, Xue H, Jiang L, Chen H, Chen L, Xie S, Wang D, Zhao M. Comparison of percutaneous transforaminal endoscopic discectomy and microscope-assisted tubular discectomy for lumbar disc herniation. Orthop Surg. 2021;13(5):1587–95. https://doi.org/10.1111/os.12909.
Miller JW, Sasso RC. Lumbar extraforaminal decompression: a technical note and retrospective study looking at potential complications as an outpatient procedure. SAS J. 2018;5(1):4–8. https://doi.org/10.1016/j.esas.2010.11.002.
O’Toole JE, Eichholz KM, Fessler RG. Minimally invasive far lateral microendoscopic discectomy for extraforaminal disc herniation at the lumbosacral junction: cadaveric dissection and technical case report. Spine J. 2007;7:414. https://doi.org/10.1016/j.spinee.2006.07.008.
Wang H, Huang B, Li C, Zhang Z, Wang J, Zheng W, Zhou Y. Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon’s training level of minimally invasive spine surgery. Clin Neurol Neurosurg. 2013;115:1987. https://doi.org/10.1016/j.clineuro.2013.06.008.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Platania, N., Paolini, F., Orlando, G., Romano, D., Maugeri, R., Iacopino, D.G. (2023). Transtubular Endoscopic Neuronavigation–Assisted Approach for Extraforaminal Lumbar Disk Herniations: A New Trend for a Common Neurosurgical Disease. In: Visocchi, M. (eds) The Funnel: From the Skull Base to the Sacrum. Acta Neurochirurgica Supplement, vol 135. Springer, Cham. https://doi.org/10.1007/978-3-031-36084-8_63
Download citation
DOI: https://doi.org/10.1007/978-3-031-36084-8_63
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-36083-1
Online ISBN: 978-3-031-36084-8
eBook Packages: MedicineMedicine (R0)