Authors: Sergio Paolini Pasquale Ciappetta Antonino Raco Paolo Missori Roberto Delfini
Publish Date: 2005/03/11
Volume: 15, Issue: 5, Pages: 554-558
Abstract
Large lumbosacral disc herniations effacing both the paramedian and the foraminal area often cause double radicular compression Surgical management of these lesions may be difficult A traditional interlaminar approach usually brings into view only the paramedian portion of the intervertebral disc unless the lateral bone removal is considerably increased Conversely the numerous farlateral approaches proposed for removing foraminal or extraforaminal disc herniations would decompress the exiting nerve root only Overall these approaches share the drawback of controlling the neuroforamen on one side alone A combined intraextraforaminal exposure is a useful yet rarely reported approach Over a 3year period 15 patients with biradicular symptoms due to large disc herniations of the lumbar spine underwent surgery through a combined intraextracanal approach A standard medial exposure with an almost complete hemilaminectomy of the upper vertebra was combined with an extraforaminal exposure achieved by minimal drilling of the inferior facet joint the lateral border of the pars interarticularis and the inferior margin of the superior transverse process The herniated discs were removed using key maneuvers made feasible by working simultaneously on both operative windows In all cases the disc herniation could be completely removed thus decompressing both nerve roots Radicular pain was fully relieved without procedurerelated morbidity The intraextraforaminal exposure was particularly useful in identifying the extraforaminal nerve root early Early identification was especially advantageous when periradicular scar tissue hid the nerve root from view as it did in patients who had undergone previous surgery at the same site or had longstanding radicular symptoms Controlling the foramen on both sides also reduced the risk of leaving residual disc fragments A curved probe was used to push the disc material outside the foramen In conclusion specific surgical maneuvers made feasible by a simultaneous extraspinal and intraspinal exposure allow quick safe and complete removal of lumbosacral disc herniations with paramedian and foraminal extension
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