Minimally invasive lumbar tubular facetectomy can be regarded as a variant of the microdiscectomy that applies to the L3-4 and L2-3 levels, where the narrow shape of the lamina and pars interarticularis forces the surgeon to remove the medial facet in order to access the disc. The L1-2 level can also be approached this way if the disc herniation is not central, since the conus medullaris typically ends at this level and therefore manipulation of the spinal sac must be minimized. This technique can also be used to remove foreign bodies, such as bullets or bone fragments.
Left L2 facetectomy for removal of large L2–3 herniated disc. Exposure of the lateral aspect of the thecal sac requires removal of the entire medial facet and the medial aspect of the lateral facet. The lateral aspect of the lateral facet is preserved, as it may be a useful anatomical landmark if percutaneous pedicle screw fixation becomes necessary (e.g., to supplement a lateral fusion) (MP4 32513 kb)
Right L2 facetectomy for bullet removal (MP4 214022 kb)
Right L4 facetectomy for bullet removal. The bullet fragment was intradural and attached to the nerve roots (MP4 24974 kb)
- 3.Kogias E, et al. Incidental durotomy in open vs. tubular revision microdiscectomy: a retrospective controlled study on incidence, management and outcome. Clin Spine Surg. 2016. doi: https://doi.org/10.1097/bsd.0000000000000279.