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Contralateral approach for minimally invasive treatment of upper lumbar intervertebral disc herniation: technical note and case series.

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Citation: World Neurosurgery. 100:583-589, 2017 AprPMID: 28137544Institution: MedStar Washington Hospital CenterDepartment: NeurosurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Diskectomy/mt [Methods] | *Intervertebral Disc Displacement/su [Surgery] | *Laminectomy/mt [Methods] | *Lumbar Vertebrae/su [Surgery] | *Minimally Invasive Surgical Procedures/mt [Methods] | *Spinal Cord Compression/su [Surgery] | Aged | Aged, 80 and over | Combined Modality Therapy/mt [Methods] | Female | Humans | Intervertebral Disc Displacement/co [Complications] | Intervertebral Disc Displacement/dg [Diagnostic Imaging] | Male | Middle Aged | Spinal Cord Compression/di [Diagnosis] | Spinal Cord Compression/et [Etiology] | Treatment OutcomeYear: 2017 ISSN:

1878-8750

Name of journal: World neurosurgeryAbstract: BACKGROUND: Upper lumbar disc herniations comprise only 1 to 2% of all lumbar disc herniations. Patients present with non-specific signs and symptoms in comparison to predictable radiculopathies as seen in lower lumbar disc herniations. The unique anatomical characteristics of the upper lumbar spine present several challenges for safe and effective surgical treatment of disc herniations. The authors review the anatomy of the upper lumbar spine, describe a novel approach to upper lumbar disc herniations, and present three cases with a focus on clinical outcome and technical pearls.CONCLUSION: A contralateral approach to perform a minimally invasive discectomy for paracentral and central upper LDH is a safe, efficient, and effective technique. The approach that we describe in this study preserves the facet complex and may prevent future spinal instability.Copyright � 2017 Elsevier Inc. All rights reserved.METHODS: Conventional techniques for upper lumbar discectomy require a near complete facetectomy and pars interarticularis resection for adequate bony exposure, possibly leading to spinal destabilization. A tubular retractor system was used to approach upper lumbar disc herniation via a contralateral minimally invasive technique, while completely preserving the facet complex and pars interarticularis.RESULTS: We report three cases of minimally invasive discectomy from a contralateral approach. The patients experienced complete resolution of presenting symptoms, and the facet complexes were preserved. All cases were free of complications.All authors: Catalino M, Jha RT, Sandhu FA, Syed HRFiscal year: FY2017Digital Object Identifier:

https://dx.doi.org/10.1016/j.wneu.2017.01.059

Date added to catalog: 2017-05-06

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	28137544	Available		28137544

BACKGROUND: Upper lumbar disc herniations comprise only 1 to 2% of all lumbar disc herniations. Patients present with non-specific signs and symptoms in comparison to predictable radiculopathies as seen in lower lumbar disc herniations. The unique anatomical characteristics of the upper lumbar spine present several challenges for safe and effective surgical treatment of disc herniations. The authors review the anatomy of the upper lumbar spine, describe a novel approach to upper lumbar disc herniations, and present three cases with a focus on clinical outcome and technical pearls.

CONCLUSION: A contralateral approach to perform a minimally invasive discectomy for paracentral and central upper LDH is a safe, efficient, and effective technique. The approach that we describe in this study preserves the facet complex and may prevent future spinal instability.

METHODS: Conventional techniques for upper lumbar discectomy require a near complete facetectomy and pars interarticularis resection for adequate bony exposure, possibly leading to spinal destabilization. A tubular retractor system was used to approach upper lumbar disc herniation via a contralateral minimally invasive technique, while completely preserving the facet complex and pars interarticularis.

RESULTS: We report three cases of minimally invasive discectomy from a contralateral approach. The patients experienced complete resolution of presenting symptoms, and the facet complexes were preserved. All cases were free of complications.

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