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Journal of Neurosurgical Sciences 2004 March;48(1):23-28

lingua: Inglese

The microsurgical approach to extraforaminal lumbar disc herniations. An analysis of 15 cases

Montinaro A.

Department of Neurosurgery “V. Fazzi” Hospital, Lecce, Italy


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Aim. Extraforaminal lum­bar ­disc her­ni­a­tions are uncom­mon, but ­thanks to ­recent ­progress in imag­ing pro­ce­dures, ­they may be eas­i­ly diag­nosed. Several sur­gi­cal approach­es ­have ­been ­described and ­employed to ­remove ­these her­ni­a­tions. The aim of ­this ­study is to eval­u­ate the clin­i­cal, radio­log­i­cal and sur­gi­cal fea­tures ­which dif­fer­en­tiate the treat­ment of ­this ­type of her­nia ­from the ­more com­mon sur­gi­cal approach­es to oth­er ­types of lum­bar ­disc her­ni­as.
Methods. The ­authors ­report the ­results of the sur­gi­cal treat­ment of 15 cas­es of extraf­o­ram­i­nal lum­bar ­disc her­ni­a­tion ­through an extra­can­a­lic­u­lar, inter­trans­verse micro­sur­gi­cal ­approach and ­describe the tech­nique ­employed.
Results. All cas­es expe­ri­enced a ­prompt recov­ery ­from the pre­op­er­a­tive symp­toms ­with no com­pli­ca­tions, ­which not­ably ­reduced the ­time nec­es­sary for ­postoper­a­tive ­care. No instabil­ity was doc­u­ment­ed and ­none of the cas­es ­observed pre­sent­ed the neu­ro­path­ic ­pain some­times report­ed ­with ­this meth­od of ­approach to ­these her­ni­a­tions.
Conclusion. This par­tic­u­lar ­site of ­disc her­ni­a­tion can be ­approached effec­tive­ly ­through the extra­can­a­lic­u­lar ­route. The pro­ce­dure, how­ev­er, ­requires an extreme­ly accu­rate pre­op­er­a­tive ana­tom­i­cal eval­u­a­tion and a ­good micro­sur­gi­cal expe­ri­ence.

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