Download PDF
Minim Invasive Neurosurg 2010; 53(3): 122-126
DOI: 10.1055/s-0030-1249102
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Minimally Invasive Approach for Far Lateral Disc Herniations: Results from 20 Patients

J.-M. Voyadzis1 , V. C. Gala2 , F. A. Sandhu1 , R. G. Fessler3
  • 1Department of Neurosurgery, Georgetown University Hospital, Washington, D.C., USA
  • 2Atlanta Brain and Spine Care, Atlanta, GA, USA
  • 3Department of Neurosurgery, Northwestern University Hospitals, Chicago, IL, USA
Further Information

Publication History

Publication Date:
31 August 2010 (online)

   Permissions and Reprints
Preview

Abstract

Background: Far lateral lumbar disc herniations, while infrequent, are a substantial cause of morbidity causing painful radicular syndromes often accompanied by a motor or sensory deficit. Surgical treatment can be challenging technically because of unfamiliar lateral anatomy and the importance of adjacent osseous structures, notably the pars interarticularis and facet joint.

Method: The traditional approach for a far lateral lumbar disc herniation involves a midline incision, wide lateral subperiosteal exposure and partial removal of these structures with the potential for iatrogenic instability. A paramedian approach to the lateral compartment of the disc space is advantageous because it directly targets the pathology. The use of recently developed minimally invasive retractor systems decreases tissue dissection and blood loss and improves postoperative recovery.

Results and Discussion: We present a series of 20 patients who underwent far lateral discectomy using a minimally invasive muscle splitting approach.

Key words

far lateral - lumbar disc herniation - minimally invasive surgery

References

  • 1 Abdullah AF, Ditto EW, Byrd EB. et al . Extreme-lateral lumbar disc herniations. Clinical syndrome and special problems of diagnosis.  J Neurosurg. 1974;  41 229-234
    Search in Google Scholar
  • 2 Abdullah AF, Wolber PG, Warfield JR. et al . Surgical management of extreme lateral lumbar disc herniations: review of 138 cases.  Neurosurgery. 1988;  22 648-653
    Search in Google Scholar
  • 3 Cervellini P, De Luca GP, Mazzetto M. et al . Micro-endoscopic-discectomy (MED) for far lateral disc herniation in the lumbar spine. Technical note.  Acta Neurochir Suppl. 2005;  92 99-101
    Search in Google Scholar
  • 4 Ehni BL, Benzel EC, Biscup RS. Lumbar discectomy. In: Benzel EC (ed.) Spine Surgery: Techniques, Complication Avoidance, and Management, 2nd edn.. Philadelphia: Elsevier Science; 2004. Vol. 1: 609-611
    Search in Google Scholar
  • 5 Ozveren MF, Bilge T, Barut S. et al . Combined approach for far-lateral lumbar disc herniation.  Neurol Med Chir (Tokyo). 2004;  44 118-122 ; discussion 123
    Search in Google Scholar
  • 6 Porchet F, Chollet-Bornand A, de Tribolet N. Long-term follow up of patients surgically treated by the far-lateral approach for foraminal and extraforaminal lumbar disc herniations.  J Neurosurg. 1999;  90 (1 Suppl) 59-66
    Search in Google Scholar
  • 7 Quaglietta P, Cassitto D, Corriero AS. et al . Paraspinal approach to the far lateral disc herniations: retrospective study on 42 cases.  Acta Neurochir Suppl. 2005;  92 115-119
    Search in Google Scholar
  • 8 Siebner HR, Faulhauer K. Frequency and specific surgical management of far lateral lumbar disc herniations.  Acta Neurochir (Wien). 1990;  105 124-131
    Search in Google Scholar
  • 9 Shao KN, Chen SS, Yen YS. et al . Far lateral lumbar disc herniation.  Zhonghua Yi Xue Za Zhi (Taipei). 2000;  63 391-398
    Search in Google Scholar
  • 10 Tessitore E, de Tribolet N. Far-lateral lumbar disc herniation: the microsurgical transmuscular approach.  Neurosurgery. 2004;  54 939-942 ; discussion 942
    Search in Google Scholar
  • 11 Eichholz KM, Hitchon PW. Far lateral lumbar disc herniation.  Contemporary Neurosurgery. 2003;  25 1-5
    Search in Google Scholar
  • 12 Epstein NE. Different surgical approaches to far lateral lumbar disc herniations.  J Spinal Disord. 1995;  8 383-394
    Search in Google Scholar
  • 13 Epstein NE. Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results.  J Neurosurg. 1995;  83 648-656
    Search in Google Scholar
  • 14 Epstein NE. Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures.  Spinal Cord. 2002;  40 491-500
    Search in Google Scholar
  • 15 Reulen HJ, Muller A, Ebeling U. Microsurgical anatomy of the lateral approach to extraforaminal lumbar disc herniations.  Neurosurgery. 1996;  39 345-350 ; discussion 350–341
    Search in Google Scholar
  • 16 Fessler RG, Khoo LT. Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience.  Neurosurgery. 2002;  51 (S 05) S37-45
    Search in Google Scholar
  • 17 Isaacs RE, Podichetty VK, Santiago P. et al . Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation.  J Neurosurg Spine. 2005;  3 98-105
    Search in Google Scholar
  • 18 Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis.  Neurosurgery. 2002;  51 (S 05) S146-S154
    Search in Google Scholar
  • 19 Le H, Sandhu FA, Fessler RG. Clinical outcomes after minimal-access surgery for recurrent lumbar disc herniation.  Neurosurg Focus. 2003;  15 E12
    Search in Google Scholar
  • 20 Perez-Cruet MJ, Kim BS, Sandhu F. et al . Thoracic microendoscopic discectomy.  J Neurosurg Spine. 2004;  1 58-63
    Search in Google Scholar
  • 21 Rosen DS, O’Toole JE, Eicholz KM. et al . Minimally invasive lumbar spinal decompression in the elderly: Outcomes of 50 patients aged 75 years and older.  Neurosurgery. 2007;  60 503-509
    Search in Google Scholar
  • 22 Sandhu FA, Santiago P, Fessler RG. et al . Minimally invasive surgical treatment of lumbar synovial cysts.  Neurosurgery. 2004;  54 107-111
    Search in Google Scholar
  • 23 O’Toole JE, Eichholz KM, Fessler RG. Minimally invasive far lateral microendoscopic discectomy for extraforaminal disc herniation at the lumbosacral junction: cadaveric dissection and technical case report.  Spine J. 2007;  7 414-421
    Search in Google Scholar
  • 24 Epimenio RO, Giancarlo D, Giuseppe T. et al . Extraforaminal lumbar herniation: „far lateral” microinvasive approach retrospective study.  J Spinal Disord Tech. 2003;  16 534-538
    Search in Google Scholar
  • 25 Rust MS, Olivero WC. Far-lateral disc herniations: the results of conservative management.  J Spinal Disord. 1999;  12 138-140
    Search in Google Scholar
  • 26 Foley KT, Smith MM, Rampersaud YR. Microendoscopic approach to far-lateral lumbar disc herniation.  Neurosurgical Focus. 1999;  7 E5
    Search in Google Scholar
  • 27 Hodges SD, Humphreys SC, Eck JC. et al . The surgical treatment of far lateral L3-4 and L4-5 disc herniations. A modified technique and outcome analysis of 25 patients.  Spine. 1999;  24 1243-1246
    Search in Google Scholar
  • 28 Wiltse LL. The paraspinal sacrospinalis-splitting approach to the lumbar spine.  Clin Orthop Relat Res. 1973;  91 48-57
    Search in Google Scholar
  • 29 Wiltse LL, Spencer CW. New uses and refinements of the paraspinal approach to the lumbar spine.  Spine. 1988;  13 696-706
    Search in Google Scholar
  • 30 Obenchain TG. Speculum lumbar extraforaminal microdiscectomy.  Spine J. 2001;  1 415-420 ; discussion
    Search in Google Scholar
  • 31 Greiner-Perth R, Bohm H, Allam Y. A new technique for the treatment of lumbar far lateral disc herniation: technical note and preliminary results.  Eur Spine J. 2003;  12 320-324
    Search in Google Scholar
  • 32 Lew SM, Mehalic TF, Fagone KL. Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations.  J Neurosurg. 2001;  94 (2 Suppl) 216-220
    Search in Google Scholar
  • 33 Yeung AT, Yeung CA. Advances in endoscopic disc and spine surgery: foraminal approach.  Surg Technol Int. 2003;  11 255-263
    Search in Google Scholar
  • 34 Sasani M, Ozer AF, Oktenoglu T. et al . Percutaneous endoscopic discectomy for far lateral lumbar disc herniations: prospective study and outcome of 66 patients.  Minim Invasive Neurosurg. 2007;  50 91-97
    Search in Google Scholar
  • 35 Zhou Y, Zhang C, Wang J. et al . Minimally invasive strategies and options for far-lateral lumbar disc herniations.  Chin J Traumatol. 2008;  11 259-266
    Search in Google Scholar

Correspondence

J.-M. VoyadzisMD 

Department of Neurosurgery

Georgetown University Hospital

7 PHC

3800 Reservoir Road, NW

Washington

D.C.20007

USA

Phone: +1/202/444 4972

Fax: +1/202/444 7344

Email: jmvoyadzis@hotmail.com