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

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.

Percutaneous Endoscopic Transforaminal Approach for Far Lateral Lumbar Discectomy: 2-Dimensional Operative Video

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.