The Translaminar Approach to Lumbar Disc Herniations Impinging the Exiting Root

Abstract Objective: We undertook a prospective, non-randomized study on the translaminar approach for the treatment of cephalad extruded disc fragments impinging the exiting root. Methods: Between May 2000 and July 2004, 104 patients (59 men)—presenting with upper lumbar root compression in 74% of the cases —underwent a translaminar approach. The mean age was 57 years (range, 27–80 yr). The lamina was approached either through the conventional subperiosteal route or via a muscle splitting access. Mostly intraforaminal disc fragments were removed through a translaminar hole 10 mm in diameter, and the disc space was cleared in cases of evident perforation of the annulus. Follow-up examinations were performed by an independent observer at 1 and 6 weeks; 3, 6, and 12 months; and once yearly thereafter (mean follow-up period, 32 mo). Results: Extruded (61%) or subligamentous (39%) disc fragments were found intra-operatively. Laminae L4 (44%) and L5 (26%) were mostly involved. In eight cases, the translaminar hole was enlarged to a conventional laminotomy. In 13 patients, the disc space was cleared. The outcomes according to the Macnab criteria were excellent (67%), good (27%), fair (5%), and poor (1%). The incidence of recurrent disc herniations was 7%. Functional radiography performed in the first 20 patients 6 months after surgery and an additional 12 patients complaining of postsurgical back pain excluded any instability. Conclusion: The translaminar approach is recommended in disc herniations encroaching the exiting root, as an alternative to the conventional interlaminar route.

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Outcomes of Discectomy in Young Adults With Large Central Lumbar Disc Herniations Presenting With Predominant Leg Pain

Global Spine Journal ◽

10.1177/2192568219856871 ◽

2019 ◽

Vol 10 (4) ◽

pp. 412-418

Author(s):

Arvind G. Kulkarni ◽

Sandeep Tapashetti

Keyword(s):

Young Adults ◽

Back Pain ◽

Lumbar Disc ◽

Young Patients ◽

Visual Analogue Score ◽

Leg Pain ◽

Disc Herniations ◽

The Mean ◽

Poor Outcomes

Study Design: Retrospective cohort study. Objectives: Discectomy alone or discectomy with fusion have been 2 polarized options in the management of large lumbar disc herniations presenting with leg-dominant pain in young patients. The objective of the study was to evaluate the outcomes of discectomy in young patients with large central lumbar disc herniation (CLDH) presenting with predominant leg pain. Material and Methods: Young patients (<45 years) presenting with predominant leg pain and MRI confirmed diagnosis of CLDH between April 2007-January 2017 were included in the study. All patients underwent tubular microdiscectomy. Outcomes of surgery were evaluated using visual analogue score (VAS) for leg and back pain, Oswestry Disability Index (ODI), and Macnab’s criteria. Results: Ninety patients fulfilled the inclusion criteria. The mean age of patients was 34.9 years (range 19-45 years). Mean follow-up was 5.09 years (range 2-10 years). The incidence of CLDH in young adults was 30% and incidence among all “operated” lumbar disc herniations was 15.9%. The mean VAS for leg pain improved from 7.48 ± 0.9 to 2.22 ± 0.84 ( P < .05) and the mean ODI changed from 60.53 ± 7.84 to 18.33 ± 6.20 ( P < .05). Fifty-nine patients (65.6%) reported excellent, 25 patients (27.8%) reported good, 3 patients each (3.3%) as fair and poor outcomes respectively. Conclusion: Discectomy alone for CLDH with predominant leg pain is associated with high success rate and low need for a secondary surgical procedure. Patient selection in terms of leg-dominant pain may be the main attribute for lower incidence of recurrence, postoperative back-pain, and instability needing a secondary procedure. Minimally invasive discectomy may provide an added advantage of preserving normal spinal anatomy, thus minimizing the need for primary spinal fusion in these patients.

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Translaminar Approach for Treatment of Hidden Zone Foraminal Lumbar Disc Herniations: Surgical Technique and Preoperative Selection of Patients with Long-Term Follow-Up

World Neurosurgery ◽

10.1016/j.wneu.2018.05.072 ◽

2018 ◽

Vol 116 ◽

pp. 182-187

Author(s):

Christian Cossandi ◽

Andrea Fanti ◽

Andrea Gerosa ◽

Andrea Bianco ◽

Riccardo Fornaro ◽

...

Keyword(s):

Surgical Technique ◽

Lumbar Disc ◽

Preoperative Selection ◽

Long Term Follow Up ◽

Disc Herniations ◽

Translaminar Approach ◽

Selection Of Patients ◽

Selection Of

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Trans-Tubular Translaminar Microscopic-Assisted Nucleotomy for Lumbar Disc Herniations in the Hidden Zone

Global Spine Journal ◽

10.1177/2192568221990421 ◽

2021 ◽

pp. 219256822199042

Author(s):

Hamdan Abdelrahman ◽

Sadat Seyed-Emadaldin ◽

Branko Krajnovic ◽

Ali Ezzati ◽

Ahmed Shawky Abdelgawaad

Keyword(s):

Lumbar Disc ◽

Minimal Invasive ◽

Leg Pain ◽

Invasive Technique ◽

Improvement Rate ◽

Neurological Improvement ◽

Minimally Invasive Surgical ◽

Disc Herniations ◽

The Mean

Study Design: A prospective cohort study in a high-flow spine center in Germany. Objectives: This study aimed to evaluate clinical outcomes and complications of the trans-tubular translaminar microscopic-assisted percutaneous nucleotomy in cases of cranially migrated lumbar disc herniations (LDH). Methods: Between January 2013 and January 2018, 66 consecutive patients with cranio-laterally migrated LDH were operated upon. The following outcome measures were evaluated: (1) Visual Analog Scale (VAS) for leg and back pain; (2) Oswestry Disability Index (ODI) and Macnab´s criteria. All patients were operated upon with trans-tubular Translaminar Microscopic-assisted Percutaneous Nucleotomy (TL-MAPN). Perioperative radiographic and clinical evaluations were reported. The mean follow-up period was 32 months. Results: The mean age was 59 years. L4/L5 was the commonest affected level (27 patients). The mean preoperative VAS for leg pain was 6.44 (±2.06), improved to 0,35 (±0.59) postoperatively. Dural injury occurred in 1 patient, treated with dural patch. Improved neurological function was reported in 41/44 Patients (neurological improvement rate of 93%) at the final follow up. There was a significant improvement in the mean ODI values, from 50.19 ± 4.92 preoperatively to 10.14 ± 2.22 postoperatively (P < 0.001). Sixty four out of 66 patients (96%) showed an excellent or good functional outcome according to Macnab´s criteria. No recurrent herniations were observed. Conclusion: The translaminar approach is a viable minimal invasive technique for cranially migrated LDH. The preservation of the flavum ligament is one of the main advantages of this technique. It is an effective, safe and reproducible minimally invasive surgical alternative in treatment of cranially migrated LDHs.

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Is Open Lumbar Micro- Discectomy Safe at Periphery of Nepal?

Nepal Journal of Neuroscience ◽

10.3126/njn.v13i1.15909 ◽

2016 ◽

Vol 13 (1) ◽

pp. 30-34

Author(s):

Bal K Thapa

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Disc Herniation ◽

Economic Status ◽

Lumbar Disc ◽

Low Back ◽

Indications For Surgery ◽

Nerve Roots ◽

Disc Herniations

Lumbar disc surgery is performed exclusively for disc herniation. Either low back pain, or sciatica or both are common presentations depending upon the levels of compressed nerve roots. Indications for surgery and MRI needs to be carefully judged upon keeping the economic status of our patients into consideration. Open lumbar (micro) discectomy is safe and successful method for lumbar disc herniations at periphery. Results in these hundred thirteen initial cases with minimum follow up of 5 years indicate that this is not only feasible but safe in these 57 males and 56 female patients aged between 12 and 93. Redo surgeries were not that difficult in this series and were safe. There were 18 cases with Multiple and 95 single levels. Of the single levels it gradually increased as the level gradually decreased in terms of the vertebral counts. L3/4: 3 cases, L4/5: 28 cases and L5/S1 : 64 cases . There were 18 cases of more than one level discs. There were 96 (Micro) discectomies, 11 Laminotomies and 6 Laminectomies.Nepal Journal of Neuroscience 13:30-34, 2016

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Neglected alkaptonuric patient presented with low back pain and radiculopathy: A case report

Surgical Neurology International ◽

10.25259/sni_1178_2021 ◽

2022 ◽

Vol 13 ◽

pp. 15

Author(s):

Mohammad Moein Vakilzadeh ◽

Sajjad Saghebdoust ◽

Bita Abbasi ◽

Reza Zare

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Disc Herniation ◽

Lumbar Disc ◽

Urine Specimen ◽

Low Back ◽

Connective Tissues ◽

Disc Space Narrowing ◽

Disc Space ◽

Disc Herniations

Background: Alkaptonuria (AKU) is a rare hereditary disorder in which excess homogentisic acid (HGA) deposits in connective tissues (ochronosis). Here, we report the unusual presentation of a lumbar disc herniation occurring in a patient with AKU warranting surgical intervention. Case Description: A 28-year-old male presented with 1 year of low back pain. The lumbar magnetic resonance imaging showed an extruded disc at the L4-L5 level accompanied extensive disc space narrowing and osteophyte formation. At surgery, the interspinous ligaments, facet joints, and disc herniation were black. In addition, the postoperative re-examination revealed a black discoloration of the nasal and ear cartilage. Finally, the diagnosis of AKU was confirmed when the urine specimen was positive for HGA. Conclusion: Rarely, younger patients with AKU who develop excess black deposits of HGA in connective tissues (i.e., ochronosis) may present with lumbar disc herniations and spondylosis.

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COMPARISON OF OPEN DISCECTOMY WITH MICROENDOSCOPIC DISCECTOMY IN LUMBAR DISC HERNIATIONS

Neurosurgery ◽

10.1227/01.neu.0000290901.00320.f5 ◽

2007 ◽

Vol 61 (3) ◽

pp. 545-549 ◽

Cited By ~ 130

Author(s):

Orlando Righesso ◽

Asdrubal Falavigna ◽

Osmar Avanzi

Keyword(s):

Hospital Stay ◽

Lumbar Disc ◽

Randomized Study ◽

Length Of Hospital Stay ◽

Neurological Status ◽

P Value ◽

Current Series ◽

Disc Herniations ◽

Microendoscopic Discectomy

Abstract OBJECTIVE We compared the intra- and postoperative differences, as well as the final outcome of patients with herniated lumbar discs who underwent either open discectomy (OD) or microendoscopic discectomy (MED). METHODS We performed a prospective controlled randomized study of 40 patients with sciatica caused by lumbar disc herniations nonresponsive to conservative treatment who underwent OD or MED with a 24-month follow-up period. Pre- and postoperative neurological status, pain, and functional outcome were evaluated. Other studied variables were the duration of the procedure, blood loss, time of hospital stay, and time to return to work. Statistical analysis with a P value less than 0.005 was carried out. RESULTS The only statistically significant differences found were for size of the incision, length of hospital stay, and operative time. The former two were greater in the OD group (P < 0.01 and P = 0.05, respectively), and the latter was greater in the MED group (P < 0.01). CONCLUSION The few parameters that were found to be statistically significant between the groups did not affect the overall outcome. In the current series, the final clinical and neurological results were similarly satisfactory in both the OD and the MED groups.

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Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

BMC Surgery ◽

10.1186/s12893-021-01255-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chunxiao Wang ◽

Yao Zhang ◽

Xiaojie Tang ◽

Haifei Cao ◽

Qinyong Song ◽

...

Keyword(s):

Blood Loss ◽

Learning Curve ◽

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Operation Duration ◽

The Mean

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

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Follow-up results of microendoscopic discectomy compared to day surgery using percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04038-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhaojun Song ◽

Maobo Ran ◽

Juan Luo ◽

Kai Zhang ◽

Yongjie Ye ◽

...

Keyword(s):

Back Pain ◽

Blood Loss ◽

Lumbar Disc ◽

Postoperative Recurrence ◽

Day Surgery ◽

Lumbar Discectomy ◽

Height Ratio ◽

Microendoscopic Discectomy ◽

Endoscopic Lumbar Discectomy

Abstract Background Percutaneous endoscopic lumbar discectomy (PELD) is satisfactory for hospitalized patients with lumbar disc herniation (LDH). Currently, only a few studies have reported about the day surgery patients undergoing PELD. Methods A total of 267 patients with LDH underwent PELD during day surgery and were followed up for at least 3 years. Clinical outcomes were assessed using the visual analog scale (VAS) for leg and lower back pain (VAS-B and VAS-L, respectively) and the Oswestry disability index (ODI). The radiological outcomes, such as lumbar lordosis (LL), sacral slope (SS), the disc-height ratio, and disc instability, were recorded and compared. The clinical effects between patients treated by PELD during day surgery and microendoscopic discectomy (MED) for contemporaneous hospitalized 116 patients with LDH were compared. Results Patients treated by PELD had lower blood loss and shorter hospital stay (P < 0.001) compared to those treated by MED. VAS-L, VAS-B, and ODI decreased significantly after PELD than before the operation and 3 years postoperatively. The postoperative VAS-B in the PELD group was significantly decreased than in the MED group (P = 0.001). The complications rate was 9.4% in the PELD group and 12.1% in the MED group (P = 0.471). The 1-year postoperative recurrence rate in the PELD group was much higher than that in MED group (P = 0.042). The postoperative LL and SS in the PELD group improved significantly compared to the values in the MED group (P < 0.001). According to the disc-height ratio at 3-year follow-up, a significant height loss was observed in the MED group than in the PELD group (P = 0.014). Conclusions Although the 1-year postoperative recurrence rate was relatively high, the day surgery for LDH undergoing PELD had advantages in terms of less blood loss intraoperatively, short hospital stay, efficacy for back pain, and efficiency to maintain lumbar physiological curvature.

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