A posterolateral microsurgical approach to extreme-lateral lumbar disc herniation

1995 ◽  
Vol 83 (4) ◽  
pp. 636-640 ◽  
Author(s):  
Michael F. O'Brien ◽  
David Peterson ◽  
H. Alan Crockard
Keyword(s):  
Posterior Approach ◽  
Lumbar Disc ◽  
Posterolateral Approach ◽  
Anatomical Landmarks ◽  
Lumbar Spinal Fusion ◽  
Bone Resection ◽  
Content Type ◽  
Disc Herniations ◽  
Microsurgical Approach ◽  
Lumbar Spinal

✓ Extreme-lateral lumbar disc herniations present a surgical challenge because the conventional posterior approach requires bone resection for complete visualization of the pathology. The authors have identified constant anatomical landmarks in cadaveric dissections that facilitate access to the intervertebral foramen when combined with a posterolateral approach, as described by Watkins, for lumbar spinal fusion. The authors describe a technique that allows rapid localization and safe excision of these extreme-lateral lumbar disc herniations without the need for bone resection.

Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine

1990 ◽  
Vol 72 (3) ◽  
pp. 378-382 ◽  
Author(s):  
Joseph C. Maroon ◽  
Thomas A. Kopitnik ◽  
Larry A. Schulhof ◽  
Adnan Abla ◽  
James E. Wilberger
Keyword(s):  
Facet Joint ◽  
Lumbar Disc ◽  
Spinal Nerve ◽  
Magnetic Resonance Images ◽  
Content Type ◽  
Enhanced Ct ◽  
Disc Herniations ◽  
Microsurgical Approach ◽  
Far Lateral ◽  
Fine Print

✓ Lumbar-disc herniations that occur beneath or far lateral to the intervertebral facet joint are increasingly recognized as a cause of spinal nerve root compression syndromes at the upper lumbar levels. Failure to diagnose and precisely localize these herniations can lead to unsuccessful surgical exploration or exploration of the incorrect interspace. If these herniations are diagnosed, they often cannot be adequately exposed through the typical midline hemilaminectomy approach. Many authors have advocated a partial or complete unilateral facetectomy to expose these herniations, which can lead to vertebral instability or contribute to continued postoperative back pain. The authors present a series of 25 patients who were diagnosed as having far lateral lumbar disc herniations and underwent paramedian microsurgical lumbar-disc excision. Twelve of these were at the L4–5 level, six at the L5–S1 level, and seven at the L3–4 level. In these cases, myelography is uniformly normal and high-quality magnetic resonance images may not be helpful. High-resolution computerized tomography (CT) appears to be the best study, but even this may be negative unless enhanced by performing CT-discography. Discography with enhanced CT is ideally suited to precisely diagnose and localize these far-lateral herniations. The paramedian muscle splitting microsurgical approach was found to be the most direct and favorable anatomical route to herniations lateral to the neural foramen. With this approach, there is no facet destruction and postoperative pain is minimal. Patients were typically discharged on the 3rd or 4th postoperative day. The clinical and radiographic characteristics of far-lateral lumbar-disc herniations are reviewed and the paramedian microsurgical approach is discussed.

Late results of cervical disc surgery

1976 ◽  
Vol 45 (2) ◽  
pp. 203-210 ◽  
Author(s):  
William Beecher Scoville ◽  
George J. Dohrmann ◽  
Guy Corkill
Keyword(s):  
Posterior Approach ◽  
Lumbar Disc ◽  
Late Results ◽  
Cord Compression ◽  
Cervical Disc ◽  
Spinal Level ◽  
Content Type ◽  
Disc Surgery ◽  
Disc Herniations ◽  
Cervical Disc Surgery

✓ Late results of cervical disc surgery have been reported and statistically studied in 383 cases; 83% were lateral discs, 13% were central spondylosis discs, and 4% central soft discs. Central spondylosis occurred at a higher spinal level, and caused cord compression with or without weakness of the hands, but no pain. A posterior approach was used in all lateral discs, and either an anterior or a posterior approach, with or without fusion, for central discs. Preoperative myelography was always done and is recommended postoperatively in central disc surgery to evaluate the results. Our results were good to excellent in 95% of lateral discs, in 64% of central spondylosis discs, and in an unexpected 91% of 11 cases of central soft discs. There were no recurrences and no serious complications, although 20% developed other cervical or lumbar disc herniations.

Microsurgical infrapedicular paramedian approach for retrovertebral lumbar disc herniations

2005 ◽  
Vol 2 (1) ◽  
pp. 88-91 ◽  
Author(s):  
Nedal Hejazi
Keyword(s):  
Facet Joint ◽  
Lumbar Disc ◽  
Clinical Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Clinical Benefits ◽  
Disc Herniations ◽  
Fine Print

✓ The author performed a microsurgical infrapedicular paramedian approach in 35 patients (23 men and 12 women) to remove herniated lumbar retrovertebral discs that did not have an apparent origin at either the superior or inferior disc level. The goal of this surgery was to minimize the bone resection, preserve the facet joint, and avoid the risk of secondary vertebral instability. The Macnab outcome classification was used to assess all patients who attended follow-up examination for at least 15 months. The clinical results were excellent or good in 34 (97%) of 35 cases. This minimally invasive lumbar spine technique resulted in minimal morbidity, excellent clinical benefits, and a long-term outcome without evidence of secondary segmental instability.

Familial lumbar spinal stenosis with acute disc herniations

1979 ◽  
Vol 51 (2) ◽  
pp. 234-236 ◽  
Author(s):  
George Varughese ◽  
Gilbert R. C. Quartey
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Case Histories ◽  
Content Type ◽  
Spinal Lesions ◽  
Hereditary Factors ◽  
Disc Herniations ◽  
Lumbar Spinal ◽  
Fine Print

✓ The case histories are reported of four brothers with lumbosciatic syndrome due to acute disc herniations, and associated spinal stenosis. Hereditary factors, although not hitherto reported, may be implicated for these spinal lesions, as the parents had also undergone spinal operations previously.

scholarly journals Chondromas of the Lumbar Spine: A Systematic Review

2020 ◽  
pp. 219256822090155
Author(s):  
Luis A. Robles ◽  
Greg M. Mundis
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Lumbar Disc ◽  
Spinal Tumor ◽  
Clinical Findings ◽  
Illustrative Case ◽  
Rim Enhancement ◽  
Disc Herniations ◽  
Meta Analyses ◽  
Lumbar Spinal

Study Design: Systematic review and illustrative case. Objectives: Lumbar spinal chondromas (LSCs) are rare spine tumors. The characteristics of these intraspinal lesions are not well described in the literature. The goal of this article is to describe the features of this rare spinal tumor. Methods: A PubMed and Scopus search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to include studies reporting patients with LSCs. The data gathered from this review was analyzed to characterize LSCs. Results: The search yielded 14 cases of patients with LSCs. All studies were case reports (Level V of evidence). Different characteristics of LSCs are described, including demographics, clinical findings, imaging, and treatment. Conclusions: The results of this review show that LSCs are almost exclusively seen in the extradural space and may adopt a dumbbell shape. LSCs frequently manifest in a very similar way to lumbar disc herniations; therefore, they should be considered in the differential diagnosis of sciatica, especially if magnetic resonance imaging with gadolinium shows peripheral rim enhancement of the lesion. Different degrees of improvement are usually observed after surgical treatment of these patients.

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