Comparative Analysis on Surgical Operability and Degree of Exposure of Microsurgical Approaches to Intraforaminal Lumbar Disk Herniations

Abstract

Background Intraforaminal lumbar disk herniations (IFDHs) represent a heterogeneous and relatively uncommon disease; their treatment is technically demanding due to the anatomical relationships with nerve roots and vertebral joints. Over time, several approaches have been developed without reaching a consensus about the best treatment strategy.

Materials and methods Authors comparatively analyze surgical operability and exposure in terms of quantitative variables between the different microsurgical approaches to IFDHs, defining the impact of each approach on surgical maneuverability and exposure on specific targets.

A comparative microanatomical laboratory investigation was conducted. The operability score (OS) was applied for quantitative analysis of surgical operability.

Results Transarticular and combined translaminar-trans-pars-interarticularis approaches result in providing the best surgical exposure and maneuverability on all targets with surgical controls on both nerve roots, at the expense of a higher risk of iatrogenic instability. Trans-pars-interarticularis approach reaches comparable levels of operability, even limited to the pure foraminal area (lateral compartment); similar findings were recorded for partial facetectomy on the medial compartment. The contralateral interlaminar approach provides good visualization of the foramen without consensual favorable maneuverability, which should be considered the main drawback.

Conclusions Approach selection has to consider disease location, the possible migration of disk fragments, the degree of nerve root involvement, and risk of iatrogenic instability. According to the findings, authors propose an operative algorithm to tailor the surgical strategy, based both on the precise definition of anatomic boundaries of exposure of each approach and on surgical maneuverability on specific targets.

Keywords

intraforaminal - disk herniation - approaches - surgical operability - operative algorithm

Permissions

Neither the article nor any part of its essential substance has been published or submitted for publication in other medical journals.

Ethical Standards

This article does not contain any studies with living human participants or animals performed by any of the authors.

Publikationsverlauf

Eingereicht: 07. Juli 2022

Angenommen: 05. Dezember 2022

Accepted Manuscript online:
08. Dezember 2022

Artikel online veröffentlicht:
11. Mai 2023

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