The Role of CT Discography in Far Lateral Disk Herniation

Abstract The conventional surgical approach to far lateral lumbar disk herniations is a paraspinal Wiltse approach. During the Wiltse approach, it is sometimes necessary to resect some of the facet or pars interarticularis to achieve an adequate exposure. The endoscopic transforaminal route can be of benefit in far lateral disk herniations due to direct access to the epidural space through Kambin's triangle, without the need for any bony removal or nerve retraction. In this video, we describe a percutaneous endoscopic transforaminal approach for far lateral discectomy in a patient presenting with a left L4 radiculopathy due to a far lateral L4-5 disk herniation. We describe Kambin's triangle anatomy and its relevance to the transforaminal route. The steps of the procedure are then described: dissection of soft tissue and removal of free disk fragments on the inferior aspect of the foramen far from the compressed exiting nerve route above to decrease the risk of retraction injury, gentle maneuvering of endoscope superiorly with removal of further compressive disk fragments, exposure of the exiting nerve root superiorly after adequate decompression is achieved and removal of any remaining fragments in close proximity to the nerve, and finally evaluation of traversing nerve root for any compressive lesions. The presentation ends with postoperative imaging confirming decompression of the far lateral disk herniation.

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Far-Lateral disk herniation: case report, review of the literature, and a description of nonsurgical management

Journal of Manipulative and Physiological Therapeutics ◽

10.1016/j.jmpt.2003.12.007 ◽

2004 ◽

Vol 27 (2) ◽

pp. 123-128 ◽

Cited By ~ 3

Author(s):

Richard E Erhard ◽

William C Welch ◽

Betty Liu ◽

M Vignovic

Keyword(s):

Case Report ◽

Review Of The Literature ◽

Disk Herniation ◽

Nonsurgical Management ◽

Far Lateral ◽

Lateral Disk

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Comparing Ipsilateral and Contralateral Laminotomy with Bilateral Decompression in Cases with Far Lateral Disk Herniation and Lumbar Spinal Stenosis

Indian Journal of Neurosurgery ◽

10.1055/s-0041-1726604 ◽

2021 ◽

Author(s):

Ezgi Akar ◽

Ahmet Öğrenci ◽

Orkun Koban ◽

Mesut Yılmaz ◽

Sedat Dalbayrak

Keyword(s):

Spinal Stenosis ◽

Contralateral Side ◽

Leg Pain ◽

Disk Herniation ◽

Unilateral Approach ◽

Vas Scores ◽

Far Lateral ◽

Lumbar Spinal ◽

Lateral Disk ◽

Group 1

Abstract Introduction The aim of this study was to compare clinical results of bilateral decompression and laminotomy and contralateral laminotomy following discectomy from the same side in patients who have far lateral disk herniation and lumbar spinal stenosis at the same level. Materials and Methods Twenty-four patients with far lateral disk herniation have been divided into two groups: group 1 (n = 14), those who have been through bilateral canal decompression with far lateral discectomy and ipsilateral approach, and group 2 (n = 10), those who have been through far lateral discectomy and bilateral decompression with unilateral approach from contralateral side. Early postoperative, 1st month, and 12th month back and leg pain Visual Analogue Scale (VAS) scores of the patients have been retrospectively evaluated. Results There is no significant difference between 1st month back and leg pain VAS scores of the groups. But 12th month back and leg pain VAS scores of group 1 are significantly higher than 1st month VAS scores. Also, 12th month back and leg pain VAS scores of group 1 are significantly higher than group 1. In the scanning carried out when the complaints of eight patients in group 1 continued, pars interarticularis fracture has been observed on the side where the surgery has been performed (57.1%). Six of these eight patients have been through stabilization surgery (42.8%). Conclusion Long-term postoperative results are better in cases who have been performed bilateral decompression with unilateral approach from contralateral side with median incision following paramedian incision discectomy in patients with far lateral disk herniation and spinal stenosis.

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Extended Transpterygoid Endonasal Far Lateral Approach: The Role of the Eustachian Tube Revised

Skull Base ◽

10.1055/s-2009-1222132 ◽

2009 ◽

Vol 19 (01) ◽

Author(s):

Paolo Battaglia ◽

Guglielmo Romano ◽

Iacopo Dallan ◽

Maurizio Bignami ◽

Luca Muscatello ◽

...

Keyword(s):

Eustachian Tube ◽

Lateral Approach ◽

Far Lateral Approach ◽

Far Lateral

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Expression of Estrogen Receptor Alpha and Evaluation of Histological Degeneration Scores in Fibroblasts of Hypertrophied Ligamentum Flavum: A Qualitative Study

Biomolecules ◽

10.3390/biom11121752 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1752

Author(s):

Christina C. Westhoff ◽

Christian-Dominik Peterlein ◽

Hanna Daniel ◽

Juergen R. Paletta ◽

Roland Moll ◽

...

Keyword(s):

Estrogen Receptor ◽

Estrogen Receptor Alpha ◽

Ligamentum Flavum ◽

Estrogen Receptor Α ◽

Group Differences ◽

Elastic Fibers ◽

Disk Herniation ◽

Spinal Decompression ◽

Lumbar Spinal

The most common spinal disorder in elderly is lumbar spinal stenosis (LSS), resulting partly from ligamentum flavum (LF) hypertrophy. Its pathophysiology is not completely understood. The present study wants to elucidate the role of estrogen receptor α (ER α) in fibroblasts of hypertrophied LF. LF samples of 38 patients with LSS were obtained during spinal decompression. Twelve LF samples from patients with disk herniation served as controls. Hematoxylin & Eosin (H&E) and Elastica stains and immunohistochemistry for ER α were performed. The proportions of fibrosis, loss and/or degeneration of elastic fibers and proliferation of collagen fibers were assessed according to the scores of Sairyo and Okuda. Group differences in the ER α and Sairyo and Okuda scores between patients and controls, male and female sex and absence and presence of additional orthopedic diagnoses were assessed with the Mann–Whitney U test. There was a tendency towards higher expression of ER α in LF fibroblasts in the hypertrophy group (p = 0.065). The Sairyo and Okuda scores were more severe for the hypertrophy group but, in general, not statistically relevant. There was no statistically relevant correlation between the expression of ER α and sex (p = 0.326). ER α expression was higher in patients with osteochondrosis but not statistically significant (p = 0.113). In patients with scoliosis, ER α expression was significantly lower (p = 0.044). LF hypertrophy may be accompanied by a higher expression of ER α in fibroblasts. No difference in ER α expression was observed regarding sex. Further studies are needed to clarify the biological and clinical significance of these findings.

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