Skip to main content
SpringerLink
Log in

Paraspinal approach to the far lateral disc herniations: retrospective study on 42 cases

  • Conference paper
Advanced Peripheral Nerve Surgery and Minimal Invasive Spinal Surgery

Part of the book series: Acta Neurochirurgica ((NEUROCHIRURGICA,volume 97))

Summary

Forty-two patients underwent surgery for far-lateral disc herniations. Average patient age was 45.1 years, 28 patients were male and 14 female. The level concerned most was L4-5 disc (55%). A paramedian muscle-splitting intertransverse approach is described for this type of disc herniation. This method allows direct visualization of the disc and root involved and does not provide bone resection and important surgical manipulation. Ninety-one percent of the patients reported excellent or good results according to Macnab outcome criteria with an average follow-up of 32.5 months (range 1–5 years). Twelve patients (28.6%) developed postoperative transient radicular pain that disappeared in 15–21 days after analgesic therapy. There were no recurrences or spinal instability.

The paramedian muscle-splitting intertransverse approach is a rational technique. Its advantages are that the spine is not opened and spinal stability is maintained. It requires minimal soft-tissue and bone resection and the herniated disc is directly visualized. Moreover, it contains minimal manipulation of the neuro-vascular structures and avoids significant muscle retraction. However, it requires an adequate learning curve and good familiarity with microsurgical techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abdullah AF, Ditto EW III, Byrd EB et al (1974) Extremelateral lumbar disk herniations. Clinical syndrome and special problems of diagnosis. J Neurosurg 41: 229–234

    PubMed  Google Scholar 

  2. Abdullah AF, Wolber PGH, Warfield JR et al (1988) Surgical management of extreme lateral lumbar disc herniations: review of l38 cases. Neurosurgery 22: 648–653

    PubMed  Google Scholar 

  3. An HS, Vaccaro A, Simeone FA et al (1990) Herniated lumbar disc in patients over the age of fifty. J Spinal Disord 3: 143–146

    PubMed  Google Scholar 

  4. Darden BV II, Wade JF, Alexander R et al (1995) Far lateral disc herniations treated by microscopic fragment excision. Techniques and results. Spine 20: 1500–1515

    PubMed  Google Scholar 

  5. Donaldson WF III, Star MJ, Thorne RP (1993) Surgical treatment for the far lateral herniated disc. Spine 18: 1263–1267

    PubMed  Google Scholar 

  6. Ebeling U, Reichenberg W, Reulen HJ (1986) Results of micro-surgical lumbar discectomy: review of 485 patients. Acta Neurochir (Wien) 81: 45–52

    Google Scholar 

  7. Epstein NE (1995) Different surgical approaches to far lateral lumbar herniations. J Spinal Disord 8: 383–394

    PubMed  Google Scholar 

  8. Epstein NE (1995) Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results. J Neurosurg 83: 648–656

    PubMed  Google Scholar 

  9. Epstein NE (2002) Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcomes measures. Spinal Cord Oct 40(10): 491–500

    Google Scholar 

  10. Epstein NE, Epstein JA, Carras R et al (1990) Far lateral lumbar disc herniations and associated structural abnormalities. An evaluation in 60 patients of the comparative value of CT, MRI, and myelo-CT in diagnosis and management. Spine 15: 534–549

    PubMed  Google Scholar 

  11. Faust SE, Ducker TB, VanHassent JA (1992) Lateral lumbar disc herniations. J Spinal Disord 5: 97–103

    PubMed  Google Scholar 

  12. Foley KT, Smith MM (1997) Microendoscopic discectomy. Tech Neurosurg 3: 301–307

    Google Scholar 

  13. Foley KT, Smith MM, Rampersand YR (1999) Micro-endoscopic approach to far-lateral lumbar disc herniation. Neurosurg Focus 7(5)

    Google Scholar 

  14. Frankhauser H, de Tribolet N (1987) Extreme lateral lumbar disc herniation. Br J Neurosurg 1: 111–129

    PubMed  Google Scholar 

  15. Farfan HF, Huberdeau RM, Dubow HI (1972) Lumbar intervertebral disc degeneration: influence of geometrical features on the pattern of disc degeneration-a post mortem study. J Bone Joint Surg (Am) 54: 492–510

    PubMed  Google Scholar 

  16. Gado M, Patel J, Hodges FJ (1983) Lateral disc herniation into the lumbar intervertebral foramen: differential diagnosis. AJNR 4: 598–600

    PubMed  Google Scholar 

  17. Garrido E, Connaughton PN (1991) Unilateral facetectomy approach for lateral lumbar disc herniation. J Neurosurg 74: 754–756

    PubMed  Google Scholar 

  18. Godersky JC, Erickson DI, Seljeskog EL (1991) Extreme lateral disc herniation: diagnosis by computed tomographic scanning. Neurosurgery 14: 549–552

    Google Scholar 

  19. Haher TR, O’Brien M, Dryer JM et al (1994) The role of the lumbarfacetjoints in spinal stability. Spine 19: 2267–2271

    PubMed  Google Scholar 

  20. Hood RS (1990) Surgical approach to far lateral disc herniation. Perspect Neurol Surg 1: 49–55

    Google Scholar 

  21. Kornberg M (1987) Extreme lateral lumbar disc herniations. Clinical syndrome and computed tomography recognition. Spine 12: 586–589

    PubMed  Google Scholar 

  22. Kunogi J, Hasue M (1991) Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine 16: 1312–1320

    PubMed  Google Scholar 

  23. Macnab I (1971) Negative disc exploration: an analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg (Am) 53: 891–903

    PubMed  Google Scholar 

  24. Maroon JC, Kopitnik TA, Schulhof LA et al (1990) Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine. J Neurosurg 72: 378–382

    PubMed  Google Scholar 

  25. Novetsky G, Berlin I, Epstein AJ et al (1982) The extraforaminal herniated disc: detection by computed tomography. AJNR 3: 653–655

    PubMed  Google Scholar 

  26. O’Hara LJ, Marshall RW (1997) Far lateral lumbar disc herniation. J Bone Joint Surg (Br) 79: 943–947

    Google Scholar 

  27. Osborn AG, Hood RS, Sherry RG (1988) CT/MR spectrum of far lateral and anterior lumbosacral disc herniations. AJNR 9: 775–778

    PubMed  Google Scholar 

  28. Osborne DR, Heinz ER, Bullard D et al (1984) Role of computed tomography in the radiological evaluation of painful radiculopathy after negative myelography: foraminal neural enrapment. Neurosurgery 14: 147–153

    PubMed  Google Scholar 

  29. Porchet F, Bornand AC, de Tribolet N (1999) Long-term follow-up of patients surgically treated by the far-lateral approach for foraminal and extraforaminal lumbar disc herniations. J Neurosurg (Spine 1) 90: 59–66

    Google Scholar 

  30. Postacchini F, Montanaro A (1979) Extreme lateral herniations of lumbardisk. Clin Orthop 138: 222–227

    PubMed  Google Scholar 

  31. Reulen H, Muller A, Ebling U (1987) The lateral approach to the “extracanalicular” lumbar disc herniation: a technical note. Acta Neurochir (Wien) 64–67

    Google Scholar 

  32. Rust MS, Olivero WC (1999) Far lateral disc herniations: the results of conservative management. J Spinal Disord 12: 138–140

    PubMed  Google Scholar 

  33. Styf J, Willen J (1998) The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans. Spine 23: 354–358

    PubMed  Google Scholar 

  34. Viswanathan R, Swamy NK, Tobler WD et al (2002) Extraforaminal lumbar disc herniations: microsurgical anatomy and surgical approach. J Neurosurg (Spine 2) 96: 206–211

    Google Scholar 

  35. Watkins MB (1953) Posterolateral fusion of the lumbar and lumbosacral spine. J Bone Joint Surg (Am) 35: 1014–1018

    PubMed  Google Scholar 

  36. Wiltse LL, Bateman JG, Hutchinson RH (1968) The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg (Am) 50: 919–926

    PubMed  Google Scholar 

  37. Wiltse LL, Spencer CW (1988) New uses and refinements of the paraspinal approach to the lumbar spine. Spine 13: 696–706

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurosurgical Unit General Hospital of Cosenza, Cosenza, Italy

    Paolo Quaglietta, D. Cassitto, A. S. Corriero & G. Corriero

Authors
  1. Paolo Quaglietta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Cassitto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. S. Corriero
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Corriero
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paolo Quaglietta .

Editor information

Editors and Affiliations

  1. EU.N.I. European Neurosurgical Institute, Treviso, Italy

    Alberto Alexandre

  2. Neurosurgical Department, Verona University, Verona, Italy

    Albino Bricolo

  3. Boltzmann Institut für Experimentelle Plastische Chirurgie, University of Vienna, Austria

    Hanno Millesi

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Springer-Verlag

About this paper

Cite this paper

Quaglietta, P., Cassitto, D., Corriero, A.S., Corriero, G. (2005). Paraspinal approach to the far lateral disc herniations: retrospective study on 42 cases. In: Alexandre, A., Bricolo, A., Millesi, H. (eds) Advanced Peripheral Nerve Surgery and Minimal Invasive Spinal Surgery. Acta Neurochirurgica, vol 97. Springer, Vienna. https://doi.org/10.1007/3-211-27458-8_25

Download citation

  • DOI: https://doi.org/10.1007/3-211-27458-8_25

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-23368-9

  • Online ISBN: 978-3-211-27458-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation