An Extreme Lateral Access for the Surgery of Lumbar Disc Herniations Inside the Spinal Canal Using the Full-Endoscopic Uniportal Transforaminal Approach–Technique and Prospective Results of 463 Patients

Spine ◽  
2005 ◽  
Vol 30 (22) ◽  
pp. 2570-2578 ◽  
Author(s):  
Sebastian Ruetten ◽  
Martin Komp ◽  
Georgios Godolias
Keyword(s):  
Spinal Canal ◽  
Lumbar Disc ◽  
Transforaminal Approach ◽  
Disc Herniations

scholarly journals Treatment of Lumbar Disc Herniations by Interventional Fluoroscopy-Guided Endoscopy

2014 ◽  
Vol 20 (5) ◽  
pp. 538-546 ◽  
Author(s):  
Juergen Reul
Keyword(s):  
Lumbar Disc ◽  
Relevant Literature ◽  
Short Review ◽  
Short Hospital Stay ◽  
Disk Herniation ◽  
Lumbar Disk Herniation ◽  
Transforaminal Approach ◽  
Disc Herniations ◽  
Microsurgical Techniques ◽  
Rehabilitation Time

The neurointerventional transforaminal endoscopic approach to sequestered disk herniation is a minimally invasive alternative to established microsurgical techniques. In addition to those techniques approaching the nucleus like APLD, the transforaminal approach allows the removal of dislocated sequesters in the epidural space. The main steps of the procedure are fluoroscopy-guided, so a good experience with fluoroscopy based interventional techniques is helpful, but the technique has a significant learning curve. If familiar with the different steps, it allows nearly every lumbar disk herniation to be treated with a very short hospital stay and short rehabilitation time. The paper describes in detail the steps of the procedure, the difficulties and advantages and gives a short review of the relevant literature.

scholarly journals Minimally invasive direct lateral, retroperitoneal transforaminal approach for large L1–2 disc herniations with intraoperative CT navigational assistance: technical note and report of 3 cases

2018 ◽  
Vol 29 (1) ◽  
pp. 46-53 ◽  
Author(s):  
Adetokunbo A. Oyelese ◽  
Jared Fridley ◽  
David B. Choi ◽  
Albert Telfeian ◽  
Ziya L. Gokaslan
Keyword(s):  
Lumbar Disc ◽  
Technical Note ◽  
Neurological Injury ◽  
Ct Guided ◽  
Intraoperative Ct ◽  
Transforaminal Approach ◽  
Endoscopic Discectomy ◽  
Disc Herniations ◽  
Poor Outcomes ◽  
Lower Lumbar

Upper lumbar (L1–2, L2–3) disc herniations are distinct in their diffuse presenting clinical symptomatology and have poorer outcomes with surgical intervention than those following mid and lower lumbar disc herniations and disc surgery. The authors present the cases of 3 patients with L1–2 disc herniations and significant stenosis of the spinal canal. The surgical approach used here combined the principles of transforaminal percutaneous endoscopic discectomy and the extreme lateral lumbar interbody fusion procedures with intraoperative CT-guided navigational assistance. The approach provides a safe corridor of direct visualization to the ventral thecal sac with minimal bony resection and could, in principle, reduce neurological injury and biomechanical instability, which likely contribute to poor outcomes at this level.

scholarly journals Does Size Matter? An Analysis of the Effect of Lumbar Disc Herniation Size on the Success of Nonoperative Treatment

2019 ◽  
Vol 10 (7) ◽  
pp. 881-887 ◽  
Author(s):  
Anmol Gupta ◽  
Shivam Upadhyaya ◽  
Caleb M. Yeung ◽  
Peter J. Ostergaard ◽  
Harold A. Fogel ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Conservative Management ◽  
Spinal Canal ◽  
Lumbar Disc ◽  
Nonoperative Treatment ◽  
Herniated Disc ◽  
Mri Scan ◽  
Cronbach's Alpha ◽  
Disc Herniations

Study Design: Retrospective study. Objective: In this study, we examined whether the size of a lumbar disc herniation (LDH) is predictive of the need for surgical intervention within 2 years after obtaining an initial magnetic resonance imaging (MRI) scan. We hypothesized that a fragment that occupied a larger percentage of the spinal canal would not predict which patients failed conservative management. Methods: Using the ICD-10 code M51.26, we identified patients at a single academic institution, across the 2-year period from 2015 to 2016, who received a diagnosis of primary lumbar radicular pain, had MRI showing a disc herniation, and underwent at least 6 weeks of nonoperative management. Patients experiencing symptoms suggesting cauda equina syndrome and those with progressive motor neurological deficits were excluded from analysis, as were patients exhibiting “hard” disc herniations. Within the axial view of an MRI, the following measurements were made on AGFA-IMPACS for a given disc herniation: the length of both the canal and the herniated disc along the anterior-posterior axis, the average width of the disc within the canal; the total canal area, and the area of the disc herniation. Data analysis was conducted in SPSS and a 2-tailed reliability analysis using Cronbach’s alpha as a measure of reliability was obtained. Results: A total of 368 patients met the inclusion and exclusion criteria for this study. Of these, 14 (3.8%) had L3-L4 herniations, 185 had L4-L5 herniations (50.3%), and 169 had L5-S1 herniations (45.9%). Overall, 336 (91.3%) patients did not undergo surgery within 1 year of the LDH diagnosis. Patients who did not receive surgery had an average herniation size that occupied 31.2% of the canal, whereas patients who received surgery had disc herniations that occupied 31.5% of the canal on average. A Cronbach’s alpha of .992 was observed overall across interobserver measurements. After controlling for age, race, gender, and location of herniation through a logistic regression, it was found that the size of the herniation and the percentage of the canal that was occupied had no predictive value with regard to failure of conservative management, generating an odds ratio for surgery of 1.00. Conclusions: The percentage of the spinal canal occupied by a herniated disc does not predict which patients will fail nonoperative treatment and require surgery within 2 years after undergoing a lumbar spine MRI scan.

scholarly journals Two Cases of Iatrogenic Lumbar Foraminal Disc Herniations

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Ryota Taniguchi ◽  
Osamu Kawano ◽  
Takeshi Maeda ◽  
Yasuharu Nakajima ◽  
Yuichiro Morishita
Keyword(s):  
Spinal Canal ◽  
Lumbar Disc ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Mr Images ◽  
Neural Foramen ◽  
Background Data ◽  
Disc Herniations ◽  
Foraminal Disc Herniation ◽  
Old Men ◽  
Liquid Medicine

Study Design. A case report. Objective. We report two cases of iatrogenic deterioration of lumbar foraminal disc herniations following lumbar disc injections. Summary of Background Data. Complications associated with discography were reported. However, only a few reports have thus far referred to the iatrogenic deterioration of lumbar foraminal disc herniations. Cases. 60-year-old and 74-year-old men were treated with MR images of L4-5 foraminal disc herniations without fragment in the spinal canal. The patients underwent discography and disc block for its diagnosis and treatment. After disc injections, both patients complained of deterioration of L4 radiculopathy. Results. On disco-CT or reexamined MR images after disc injections, herniated fragment was migrated from neural foramen to cranial central spinal canal with was not shown in previous MR images. The herniated fragments were extirpated by means of osteoplastic laminoplasty or transforaminal lumbar interbody fusion with facetectomy. The herniated fragments were migrated from neural foramen to cranial central spinal canal. Conclusions. The injection of liquid medicine into the nucleus led the intradiscal pressure increased, and the disc fragment might prolapsed through the raptured region of annulus fibrosus and migrated to cranial central spinal canal by anatomical reason. The disc injection may have a risk for deterioration of foraminal disc herniation. Our report is instructive for the management of discography for the diagnosis of foraminal disc herniations.

scholarly journals Transforaminal Approach in Thoracal Disc Pathologies: Transforaminal Microdiscectomy Technique

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Sedat Dalbayrak ◽  
Onur Yaman ◽  
Kadir Öztürk ◽  
Mesut Yılmaz ◽  
Mahmut Gökdağ ◽  
...  
Keyword(s):  
Spinal Canal ◽  
Minimal Invasive ◽  
Surgical Approaches ◽  
Invasive Approach ◽  
Transforaminal Approach ◽  
Minimal Invasive Approach ◽  
Disc Herniations ◽  
The Mean ◽  
Thoracic Disc

Objective. Many surgical approaches have been defined and implemented in the last few decades for thoracic disc herniations. The endoscopic foraminal approach in foraminal, lateral, and far lateral disc hernias is a contemporary minimal invasive approach. This study was performed to show that the approach is possible using the microscope without an endoscope, and even the intervention on the discs within the spinal canal is possible by having access through the foramen.Methods.Forty-two cases with disc hernias in the medial of the pedicle were included in this study; surgeries were performed with transforaminal approach and microsurgically. Extraforaminal disc hernias were not included in the study. Access was made through the Kambin triangle, foramen was enlarged, and spinal canal was entered.Results.The procedure took 65 minutes in the average, and the mean bleeding amount was about 100cc. They were mobilized within the same day postoperatively. No complications were seen. Follow-up periods range between 5 and 84 months, and the mean follow-up period is 30.2 months.Conclusion.Transforaminal microdiscectomy is a method that can be performed in any clinic with standard spinal surgery equipment. It does not require additional equipment or high costs.

scholarly journals Detection of Degenerative Changes on MR Images of the Lumbar Spine with a Convolutional Neural Network: A Feasibility Study

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 902
Author(s):  
Nils Christian Lehnen ◽  
Robert Haase ◽  
Jennifer Faber ◽  
Theodor Rüber ◽  
Hartmut Vatter ◽  
...  
Keyword(s):  
Neural Network ◽  
Lumbar Spine ◽  
Diagnostic Accuracy ◽  
Nerve Root ◽  
Spinal Canal ◽  
Spinal Canal Stenosis ◽  
Degenerative Changes ◽  
High Diagnostic Accuracy ◽  
Canal Stenosis ◽  
Disc Herniations

Our objective was to evaluate the diagnostic performance of a convolutional neural network (CNN) trained on multiple MR imaging features of the lumbar spine, to detect a variety of different degenerative changes of the lumbar spine. One hundred and forty-six consecutive patients underwent routine clinical MRI of the lumbar spine including T2-weighted imaging and were retrospectively analyzed using a CNN for detection and labeling of vertebrae, disc segments, as well as presence of disc herniation, disc bulging, spinal canal stenosis, nerve root compression, and spondylolisthesis. The assessment of a radiologist served as the diagnostic reference standard. We assessed the CNN’s diagnostic accuracy and consistency using confusion matrices and McNemar’s test. In our data, 77 disc herniations (thereof 46 further classified as extrusions), 133 disc bulgings, 35 spinal canal stenoses, 59 nerve root compressions, and 20 segments with spondylolisthesis were present in a total of 888 lumbar spine segments. The CNN yielded a perfect accuracy score for intervertebral disc detection and labeling (100%), and moderate to high diagnostic accuracy for the detection of disc herniations (87%; 95% CI: 0.84, 0.89), extrusions (86%; 95% CI: 0.84, 0.89), bulgings (76%; 95% CI: 0.73, 0.78), spinal canal stenoses (98%; 95% CI: 0.97, 0.99), nerve root compressions (91%; 95% CI: 0.89, 0.92), and spondylolisthesis (87.61%; 95% CI: 85.26, 89.21), respectively. Our data suggest that automatic diagnosis of multiple different degenerative changes of the lumbar spine is feasible using a single comprehensive CNN. The CNN provides high diagnostic accuracy for intervertebral disc labeling and detection of clinically relevant degenerative changes such as spinal canal stenosis and disc extrusion of the lumbar spine.

Long-term follow-up of standard microdiscectomy versus minimal access surgery for lumbar disc herniations

2013 ◽  
Vol 155 (12) ◽  
pp. 2333-2338 ◽  
Author(s):  
J. Gempt ◽  
M. Jonek ◽  
F. Ringel ◽  
A. Preuß ◽  
P. Wolf ◽  
...  
Keyword(s):  
Lumbar Disc ◽  
Minimal Access Surgery ◽  
Minimal Access ◽  
Long Term Follow Up ◽  
Disc Herniations ◽  
Access Surgery

Surgical treatment of intraforaminal/extraforaminal lumbar disc herniations: Many approaches for few surgical routes

2017 ◽  
Vol 159 (7) ◽  
pp. 1273-1281 ◽  
Author(s):  
Giorgio Lofrese ◽  
Lorenzo Mongardi ◽  
Francesco Cultrera ◽  
Giorgio Trapella ◽  
Pasquale De Bonis
Keyword(s):  
Surgical Treatment ◽  
Lumbar Disc ◽  
Disc Herniations
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