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Full-endoscopic trans-pars interarticularis approach for far lateral lumbar discectomy

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Abstract

Purpose

Surgical management of far lateral disc herniations remains challenging. Current transforaminal full-endoscopic approaches require non-visualized docking in the Kambin’s triangle and have been associated with significant risk of inadvertent nerve injury. We develop a full-endoscopic approach based on reliable bony landmarks allowing for visualization of the exiting nerve root prior to the far lateral discectomy.

Methods

The surgical details of a full-endoscopic trans-pars interarticularis approach for far lateral discectomy are described. These descriptions include high quality intraoperative images and important surgical pearls. A small patient cohort is presented to demonstrate feasibility and safety of the procedure.

Results

We demonstrate the feasibility of this approach in 14 patients with a mean age of 59.5 ± 14.7 years. At a mean follow up of 21.9 ± 6.8 months, improvement of the visual analogue scale (VAS) for leg pain was 4.3 ± 1.0 resulting in minimally clinically important difference in 78.6% of the patients. The mean improvement in VAS for the back pain was 2.6 ± 0.8 and for Oswestry disability index (ODI) was 20.6 ± 5.3. Nuances of the trans-pars surgical techniques are presented in a patient with a right-sided L4-5 far lateral disc herniation. Preoperative imaging studies, steps of the surgical progression, and intraoperative views are described in detail.

Conclusion

Using the pars interarticularis as the bony target area allows for safe visualized access to the extraforaminal compartment of the exiting nerve root. This novel surgical technique has the potential benefit of decreasing inadvertent neural injury and subsequent postoperative dysesthesias.

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Data availability

All data generated or analyzed during this study are included in this manuscript.

Abbreviations

MIS:

Minimally-invasive

ODI:

Oswestry disability index

SAP:

Superior articular process

VAS:

Visual analogue scale

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Acknowledgements

The authors would like to thank Sharon Durfy, PhD, for her assistance with manuscript preparation. The research team would like to extend thanks to the Endoscopic Spine Research Group (ESRG) of which JIO, ONK, and CPH are members

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Harborview Medical Center, Department of Neurological Surgery, University of Washington, 325 Ninth AVE, Seattle, WA, 98104, USA

    Madeline E. Greil, John R. Williams & Christoph P. Hofstetter

  2. Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA

    Julia Bergquist

  3. Department of Neurological Surgery, University of Michigan, Ann Arbor, MI, USA

    Osama N. Kashlan

  4. Department of Neurological Surgery, Washington University, St. Louis, MO, USA

    John I. Ogunlade

Authors
  1. Madeline E. Greil
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  2. John I. Ogunlade
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  3. Julia Bergquist
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  4. John R. Williams
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  5. Osama N. Kashlan
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  6. Christoph P. Hofstetter
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Contributions

CPH contributed to Conceptualization and Design; MEG, JB contributed to Acquisition of Data; MEG, CPH contributed to Analysis and Interpretation of Data; MEG, JIO, JRW, ONK contributed to Drafting the Article; MEG, ONK, CPH cpntributed to Critically Revising Article Critically; all authors contributed to Review Submitted Version of Manuscript; CPH contributed to Statistical Analysis; ONK, CPH contributed to Study Supervision.

Corresponding author

Correspondence to Christoph P. Hofstetter.

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Conflict of interest

Dr. Hofstetter is a consultant for Joimax, Globus, Medical, Innovasis, and Johnson & Johnson.

Ethical standard

The University of Washington Human Subjects Division reviewed and approved this retrospective research study (IRB07742) with a waiver of informed consent, appropriately compliant with institutional requirements, and conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

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Greil, M.E., Ogunlade, J.I., Bergquist, J. et al. Full-endoscopic trans-pars interarticularis approach for far lateral lumbar discectomy. Eur Spine J 32, 2709–2716 (2023). https://doi.org/10.1007/s00586-023-07698-1

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  • DOI: https://doi.org/10.1007/s00586-023-07698-1

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