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Gokyar A, Tonga F. Clinical experience on intertransverse extraforaminal approach for far lateral disc herniations: 132 cases. Niger J Clin Pract 2022; 25:630-635. [PMID: 35593605 DOI: 10.4103/njcp.njcp_1588_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Far lateral disc herniations attract many spine surgeons for their type of onset, degree of pain, risk of neurological deficit, and increasing incidence. Today, a direct approach to the region by miminally invasive techniques is preferred. Aims We aimed to present the results of the cases that were operated via intertransverse extraforaminal approach through a midline incision. Patients and Methods One hundred thirty-two patients who were operated for far lateral disc herniation by extraforaminal approach between January 2010 and December 2017 were retrospectively evaluated. The demographical data, level of disc herniations, examination findings, preoperative and postoperative VAS scores, and postoperative long-term MacNab satisfaction rates were recorded. Results Sixty-nine of the patients were male. The mean age was 58.1 years. Acute onset pain was a dominant complaint in 75% of the cases. The mean preoperative VAS score of 8.24 decreased to 2.08 at one month postoperatively. Based on a mean follow-up of 34.4 months, the long-term satisfaction rates according to Macnab criteria were 74% excellent-good, 20% moderate, and 6% poor. Conclusion Intertransverse extraforaminal approach is an effective and safe technique for far lateral disc herniations. However, considering the anatomical restrictions and the unfamiliarity of the surgeons with the region, it is important that the surgeons perform the surgery with the technique they know best to increase the success of the surgery.
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Affiliation(s)
- A Gokyar
- Department of Neurosurgery, Medical Faculty of Amasya, Turkey
| | - F Tonga
- Department of Neurosurgery, Medical Faculty of Amasya, Turkey
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Borja AJ, Connolly J, Kvint S, Detchou DKE, Glauser G, Strouz K, McClintock SD, Marcotte PJ, Malhotra NR. Charlson Comorbidity Index score predicts adverse post-operative outcomes after far lateral lumbar discectomy. Clin Neurol Neurosurg 2021; 206:106697. [PMID: 34030078 DOI: 10.1016/j.clineuro.2021.106697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Charlson Comorbidity Index (CCI) score has been shown to predict 10-year all-cause mortality and post-neurosurgical complications but has never been examined in a far lateral disc herniation (FLDH) population. This study aims to correlate CCI score with adverse outcomes following FLDH repair. PATIENTS AND METHODS All patients (n = 144) undergoing discectomy for FLDH at a single, multihospital academic medical system (2013-2020) were retrospectively analyzed. CCI scores were determined for all patients. Univariate logistic regression was used to determine the ability of CCI score to predict adverse outcomes. RESULTS Mean age of the population was 61.72 ± 11.55 years, 69 (47.9%) were female, and 126 (87.5%) were non-Hispanic white. Patients underwent either open (n = 92) or endoscopic (n = 52) FLDH repair. Average CCI score among the patient population was 2.87 ± 2.42. Each additional point in CCI score was significantly associated with higher rates of readmission (p = 0.022, p = 0.014) in the 30-day and 30-90-day post-surgery window, respectively, and emergency department visits (p = 0.011) within 30-days. CCI score also predicted risk of reoperation of any kind (p = 0.013) within 30 days of the index operation. In addition, CCI score was predictive of risk of reoperation of any kind (p = 0.008, p < 0.001; respectively) and repeat neurosurgical intervention (p = 0.027, p = 0.027) within 30-days and 90-days of the index admission (either during the same admission or after discharge). CONCLUSIONS This study suggests that CCI score is a useful metric to predict of numerous adverse postoperative outcomes following discectomy for FLDH.
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Affiliation(s)
- Austin J Borja
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John Connolly
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Svetlana Kvint
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Donald K E Detchou
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Krista Strouz
- McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, PA, USA; West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, PA, USA
| | - Scott D McClintock
- West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, PA, USA
| | - Paul J Marcotte
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, PA, USA.
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Nicoletti GF, Umana GE, Chaurasia B, Ponzo G, Giuffrida M, Vasta G, Tomasi SO, Graziano F, Cicero S, Scalia G. Navigation-assisted extraforaminal lumbar disc microdiscectomy: Technical note. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:316-320. [PMID: 33824562 PMCID: PMC8019114 DOI: 10.4103/jcvjs.jcvjs_146_20] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/16/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Extraforaminal lumbar disc herniation (ELDH) amounts of 7%–12% of all lumbar disc herniations. Although they have already been widely described, an optimal treatment is still under discussion in the literature. Objective: We describe a novel application of navigation using 2D/3D imaging system to plan an adequate surgical trajectory and performing a neuronavigated microdiscectomy in ELDH that has not been previously described. Methods: This is a retrospective study in a single institution. Between February 2017 and July 2020, a total of 12 patients (7 males and 5 females), with a mean age of 56 years (range 49–71 years), have been treated because of ELDH through a far lateral microdiscectomy using 2D/3D imaging system-assisted neuronavigation (O-arm). Results: No intraoperative and/or postoperative complications were recorded. Patients presented a mean preoperative Visual Analog Scale (VAS) score of 7.83 ± 0.83 (range 7–9). At the day of discharge, leg pain VAS score effectively improved, decreasing to a mean value of 1.83 ± 0.83 (range 1–3). Further, low back and radicular pain improvement was recorded at 1-, 6-, and 12-month follow-up, respectively. Conclusion: We described a novel use of 2D/3D imaging system navigation in the microsurgical treatment of ELDH that has not previously reported. This technique is safe and effective and provides more intraoperative details compared to fluoroscopy, which can be crucial for the success of the procedure and to reduce complications and particularly indicated in complex cases with altered anatomy.
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Affiliation(s)
- Giovanni Federico Nicoletti
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Giancarlo Ponzo
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Massimiliano Giuffrida
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Giuseppe Vasta
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Santino Ottavio Tomasi
- Department of Neurological Surgery - Christian Doppler Klinik Paracelsus Medical University, Salzburg, Austria.,Department of Neurosurgery, Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, Salzburg, Austria
| | - Francesca Graziano
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy.,Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo, Italy
| | - Salvatore Cicero
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
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Alimi M, Njoku I, Cong GT, Pyo SY, Hofstetter CP, Grunert P, Härtl R. Minimally Invasive Foraminotomy Through Tubular Retractors via a Contralateral Approach in Patients With Unilateral Radiculopathy. Oper Neurosurg (Hagerstown) 2014; 10 Suppl 3:436-47; discussion 446-7. [DOI: 10.1227/neu.0000000000000358] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Radiculopathy caused by foraminal nerve root compression is a common pathology in the lumbar spine. Surgical decompression via a conventional open foraminotomy is the treatment of choice when surgery is indicated. Minimally invasive tubular foraminotomy through a contralateral approach is a potentially effective surgical alternative.
OBJECTIVE:
The aim of this retrospective cohort study was to evaluate the efficacy and benefits of this approach for treatment of radiculopathy.
METHODS:
Patients with unilaterally dominant lower extremity radiculopathy, who underwent minimally invasive lumbar foraminotomy through tubular retractors via a contralateral approach between 2010 and 2012, were included. Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS) for back and leg pain were evaluated preoperatively, postoperatively, and at the latest follow-up. Functional outcome was evaluated by using the MacNab criteria.
RESULTS:
For the total 32 patients, postoperatively there was significant improvement in the ODI (P = .006), VAS back pain (P < .001), and VAS leg pain on the pathology and the approach side (P = .004, P = .021, respectively). At follow-up of 12.3 ± 1.7 months, there was also significant improvement in the ODI (P < .001), VAS back pain (P = .001), and VAS leg pain on the pathology and the approach side (P < .001, P = .001, respectively). The functional outcome was excellent and good in 95.2%. One patient required fusion (3.1%).
CONCLUSION:
A minimally invasive, facet-sparing contralateral approach is an effective technique for treatment of radiculopathy due to foraminal compression. It also allows for decompression of lumbar spinal stenosis and bilateral lateral recess decompression without the need for fusion.
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Affiliation(s)
- Marjan Alimi
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | | | | | - Se Young Pyo
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Christoph P. Hofstetter
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Peter Grunert
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
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Pirris SM, Dhall S, Mummaneni PV, Kanter AS. Minimally invasive approach to extraforaminal disc herniations at the lumbosacral junction using an operating microscope: case series and review of the literature. Neurosurg Focus 2008; 25:E10. [DOI: 10.3171/foc/2008/25/8/e10] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgical access to extraforaminal lumbar disc herniations is complicated due to the unique anatomical constraints of the region. Minimizing complications during microdiscectomies at the level of L5–S1 in particular remains a challenge. The authors report on a small series of patients and provide a video presentation of a minimally invasive approach to L5–S1 extraforaminal lumbar disc herniations utilizing a tubular retractor with microscopic visualization.
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Affiliation(s)
- Stephen M. Pirris
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sanjay Dhall
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V. Mummaneni
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Adam S. Kanter
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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O'Toole JE, Eichholz KM, Fessler RG. Minimally invasive far lateral microendoscopic discectomy for extraforaminal disc herniation at the lumbosacral junction: cadaveric dissection and technical case report. Spine J 2007; 7:414-21. [PMID: 17630139 DOI: 10.1016/j.spinee.2006.07.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2006] [Revised: 06/05/2006] [Accepted: 07/06/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Extraforaminal lumbar disc herniations (ELDHs) at the lumbosacral junction are an uncommon cause of L5 radiculopathy. The surgical anatomy of the extraforaminal space at L5-S1 is uniquely challenging for the various open surgical approaches that have been described for ELDHs in general. Reports specifically describing minimally invasive surgical approaches to lumbosacral ELDHs are lacking. PURPOSE To report the novel use of a far lateral microendoscopic (FLMED) approach to lumbosacral ELDH. To better define the unique anatomical features of extraforaminal approaches to the lumbosacral junction as they apply to minimal access techniques. STUDY DESIGN/SETTING A cadaveric investigation and clinical case were performed at a single institution. A thorough review of the literature was conducted. PATIENT SAMPLE A single patient with an extraforaminal disc herniation at the lumbosacral junction underwent evaluation and surgery. OUTCOME MEASURES The patient's self-reported pain levels were documented. Physiologic outcome was judged on pre- and postoperative motor and sensory examinations. Functional capacity was assessed by work status and ability to perform activities of daily living. METHODS FLMED was performed in two fresh human cadavers at the lumbosacral junction. Qualitative assessments of the surgical anatomy were made, and intraoperative fluoroscopy and endoscopic photographs were obtained to document the findings. A patient with refractory pain and sensorimotor deficits from compression of the L5 nerve root by an ELDH underwent FLMED. The literature was carefully reviewed for the epidemiology of ELDHs at the lumbosacral junction and the surgical techniques used to treat them. RESULTS The posterolateral surgical corridor to the lumbosacral disc was consistently constrained by the sacral ala and to a lesser extent the lateral facet and L5 transverse process. Resection of the superior ala exposed the exiting nerve root and provided ample access to the disc. In the clinical case, the patient enjoyed immediate pain relief, was discharged in 3 hours, and returned to full work and social activities. Follow-up neurological examination revealed no sensory or motor deficit. CONCLUSIONS FLMED offers a safe and efficacious approach to ELDHs at the lumbosacral junction by combining satisfactory visualization for adequate resection of the sacral ala with the benefits of reduced tissue injury and faster recovery times that accompany minimally invasive techniques.
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Affiliation(s)
- John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison Street, Chicago, IL 60612, USA.
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