Summary
Seventy-three patients presenting either with biradicular symptoms caused by involvement of the upper and lower root or with monoradicular symptoms caused by affection of the upper root were treated between January 1993 and July 1995 in our department. An interlaminar and lateral access was used to decompress both the upper and lower root by combining the conventional interlaminar approach and a lateral partial facetectomy. With this technique, satisfactory to excellent results were obtained in 92% of the patients. The advantages of the combined approach are (i) optimized visualization of the disc and surrounding anatomical structures, (ii) improved exposure of the lateral foramen and thorough removal of disc material, (iii) minimal risk of root injury by improved visualization, (iv) preservation of a functional facet joint and thereby reduction of postoperative instability with persistent back pain. Since occasionally lateral disc herniations are poorly visualized by computed tomography or magnetic resonance imaging, the decision to use the combined approach should be guided by the patient's clinical presentation rather than by radiological findings.
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References
Abdullah AF, Wolber PGH, Warfield JR, Gunadi IK (1988) Surgical management of extreme lateral lumbar disc herniations: review of 138 cases. Neurosurgery 22: 648–653
Epstein NE, Epstein JA, Carras R, Hyman RA, Murthy Vishnubakat S (1986) Far lateral disc herniation: diagnosis and surgical management. Neuroorthopedics 1: 37–44
Epstein NE (1995) Evaluation of varied surgical approaches used in the management of 170 farlateral lumbar disc herniations: indications and results. J Neurosurg 83: 648–656
Fankhauser H, de Tribolet N (1987) Extreme lateral lumbar disc herniation. Br J Neurosurg 1: 111–129
Garrido E, Connaughton PN (1991) Unilateral facetectomy approach for lateral lumbar disc herniation [see comments], J Neurosurg 74: 754–756
Grob D, Scheier D (1987) Reintervention bei postoperativer Instabilität an der Lendenwirbelsäule. Orthopäde 16: 348–356
Lejeune JP, Hladky JP, Gotten A, Vinchon M, Christiaens JL (1994) Foraminal lumbar disc herniation. Experience with 83 patients. Spine 19: 1905–1908
Oeckler R, Hamburger C, Schmiedek P, Haberl H (1992) Surgical observations in extremely lateral lumbar disc herniation. Neurosurg Rev 15: 255–258
O'Brien MF, Peterson D, Crockard HA (1995) A posterolateral microsurgical approach to extreme-lateral lumbar disc herniation. J Neurosurg 83: 636–640
Patrick BS (1975) Extreme lateral ruptures of lumbar intervertebral discs. Surg Neurol 3: 301–303
Reulen HJ, Pfaundler S, Ebeling U (1987) The lateral microsurgical approach to the “extracanalicular” lumbar disc herniation. I: A technical note. Acta Neurochir (Wien) 84: 64–67
Schlesinger SM, Fankhauser H, de Tribolet N (1992) Microsurgical anatomy and operative technique for extreme lateral lumbar disc herniations. Acta Neurochir (Wien) 118: 117–129
Siebner HR, Faulhauer K (1990) Frequency and specific surgical management of far lateral lumbar disc herniations. Acta Neurochir (Wien) 105: 124–131
White AA, Panjabi MM (1978) The problem of clinical instability in the human spine: a systematic approach. Lippincott, Philadelphia, pp 251–264
References
Maroon IC, Kopitnik TA, Schulhof LA, Abla A, Wilberger IE (1990) Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine (see comments). J Neurosurg 72: 378–382
Markwalder TM, Reulen HJ (1989) Translaminar screw fixation in lumbar spine pathology. Acta Neurochir (Wien) 99: 58–60
Recoules-Arche D (1985) La chirurgie de la hernie discale du canal de conjugaison lombaire. Neurochirurgie 31: 61–64
Reulen HJ. Müller A, Ebeling U (1995) Microsurgical anatomy of the lateral approach to extraforaminal lumbar disc herniation. Neurosurgery: in press
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Hassler, W., Brandner, S. & Slansky, I. Microsurgical management of lateral lumbar disc herniations: Combined lateral and interlaminar approach. Acta neurochir 138, 907–911 (1996). https://doi.org/10.1007/BF01411277
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DOI: https://doi.org/10.1007/BF01411277