Localisation of spinal level in lumbar microdiscectomy

  • Paraskumar MohanlalEmail author
  • Debasish Pal
  • Jake Timothy
Original Article


The microsurgical approach for removal of prolapsed lumbar disc has gained popularity because of its various advantages. Localisation of the correct level is vital for the success of this procedure. We performed an audit to review our practice regarding the localisation of correct level in lumbar microdiscectomy. Twenty-eight patients were included in this study. Nearly, two-third of the patients had needles as pre-operative marker of localisation and in more than 50% the needle was inserted perpendicular to the floor. When using a needle to localise the spinal level, care should be taken to insert it perpendicular to the floor or parallel to the disc space to avoid approaching the wrong level. The gold standard is an intraoperative lateral fluoroscopy of the spine with a marker in the disc space.


Microdiscectomy Lumbar Localisation Level 

Localisation du niveau vertébral dans la microdiscectomie lombaire


L’abord microchirurgical pour l’ablation des prolapsus discaux lombaires a gagné en popularité de par ses nombreux avantages. Le repérage exact du niveau est indispensable au succès. Nous avons réalisé un audit pour revoir notre pratique concernant ce repérage lors de la discectomie microchirurgicale. Vingt huit patients ont été inclus dans cette étude. Environ deux tiers des patients avaient eu une implantation d’aiguille en marquage pré-opératoire et dans plus de 50% des cas, cette aiguille avait été placée perpendiculairement par rapport au sol. Lorsque l’on utilise ce procédé, il faut faire attention de bien placer l’aiguille perpendiculairement par rapport au sol ou bien de façon parallèle au disque, pour éviter toute erreur de niveau. Le « gold standard » consiste à utiliser un contrôle fluoroscopique per-opératoire du rachis avec un marquage de l’espace discal.

Mots clés

Microdiscectomie Lombaire Repérage Niveau 


  1. 1.
    Brody F, Rosen M, Tarnoff M, et al (2002) Laparoscopic lateral L4–5 disc exposure. Surg Endosc 16:650–653CrossRefPubMedGoogle Scholar
  2. 2.
    Caspar W (1977) A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. Adv Neurosurg 4:74–80Google Scholar
  3. 3.
    Deen HG (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 15:2081–2082CrossRefGoogle Scholar
  4. 4.
    Dolan P, Greenfield K, Nelson RJ, et al (2000) Can exercise therapy improve the outcome of Microdiscectomy? Spine 25(12):1523–1532CrossRefPubMedGoogle Scholar
  5. 5.
    Haines SJ, Jordan N, Boen JR, et al (2002) Discectomy strategies for lumbar disc herniation: study design and implications for clinical research. J Clin Neurosci 9:440–446CrossRefPubMedGoogle Scholar
  6. 6.
    Javedan S, Sonntag VK (2003) Lumbar disc herniation: microsurgical approach. Neurosurgery 52:160–162CrossRefPubMedGoogle Scholar
  7. 7.
    Javid MJ (1995) Chemonucleolysis versus laminectomy. A cohort comparison of effectiveness and charges. Spine 20:16–22CrossRefGoogle Scholar
  8. 8.
    Khoo LT, Fessler RG (2002) Microendoscopic decompressive laminectomy for the treatment of lumbar stenosis. Neurosurgery 51:146–154Google Scholar
  9. 9.
    Maroon JC (2002) Current concepts in minimally invasive discectomy. Neurosurgery 51:137–145CrossRefGoogle Scholar
  10. 10.
    McAfee PC, Lee GA, Fedder IL, et al (2002) Anterior BAK instrumentation and fusion: complete versus partial discectomy. Clin Orthop 394:55–63PubMedCrossRefGoogle Scholar
  11. 11.
    Mixter WJ, Barr JS (1934) Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 211:210–215CrossRefGoogle Scholar
  12. 12.
    Nakagawa H, Kamimura M, Uchiyama S, et al (2003) Microendoscopic discectomy (MED) for lumbar disc prolapse. J Clin Neurosci 10:231–235CrossRefPubMedGoogle Scholar
  13. 13.
    Schick U, Dohnert J (2002) Technique of microendoscopy in medial lumbar disc herniation. Minim Invasive Neurosurg 45:139–141CrossRefPubMedGoogle Scholar
  14. 14.
    Williams RW (1978) Micro lumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc. Spine 3:75–82CrossRefGoogle Scholar
  15. 15.
    Williams RW (1993) Lumbar disc disease. Microdiscectomy. Neurosurg Clin N Am 4:101–118PubMedGoogle Scholar
  16. 16.
    Williams RW (1986) Microlumbar discectomy. A 12-year statistical review. Spine 11:851–852PubMedCrossRefGoogle Scholar
  17. 17.
    Woodard EJ, Leon SP, Moriarty TM, et al (2001) Initial experience with intraoperative magnetic resonance imaging in spine surgery. Spine 26(4):410–417CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Paraskumar Mohanlal
    • 1
    Email author
  • Debasish Pal
    • 1
  • Jake Timothy
    • 1
  1. 1.Department of NeurosurgeryLeeds General InfirmaryLeedsUK

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