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Surgical observations in extremely lateral lumbar disc herniation.
R Oeckler1, C Hamburger, P Schmiedek
1Neurosurgical Clinic, Ludwig Maximilians University of Munich, Fed. Rep. of Germany.
Neurosurgical Review
|January 1, 1992
Summary
Extracanalicular lumbar disc herniations, though rare, present unique diagnostic and surgical challenges. A microsurgical approach offers good outcomes for these challenging cases.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Imaging
Background:
- Extracanalicular lumbar disc herniations (ELDH) represent approximately 10% of cases.
- These herniations cause characteristic nerve root compression with minimal back pain.
- Diagnosis is challenging due to the "hidden" location, often requiring advanced imaging.
Purpose of the Study:
- To evaluate the diagnostic and surgical outcomes of extracanalicular lumbar disc herniations.
- To assess the efficacy of different surgical approaches for ELDH.
- To identify factors influencing surgical success in ELDH.
Main Methods:
- Retrospective analysis of 15 patients with ELDH.
- Surgical interventions included the lateral microsurgical approach (REULEN) and a combined lateral sequestrotomy/medial nucleotomy.
- High-resolution spinal computed tomography (CT) was utilized for diagnosis.
Main Results:
- 13 out of 15 patients achieved good outcomes with symptom remission.
- The lateral microsurgical approach was used in 10 patients, with 3 requiring subsequent medial nucleotomy due to re-sequestration.
- Two patients with concurrent spondylolisthesis experienced persistent back pain but reduced radicular symptoms.
Conclusions:
- Extracanalicular lumbar disc herniations can be effectively treated with microsurgical techniques.
- The lateral microsurgical approach, sometimes combined with medial nucleotomy, yields favorable results.
- Accurate diagnosis with high-resolution CT is crucial for successful surgical management of ELDH.