Extraperitoneal anterolateral discectomy for lumbar disc herniation: indications, techniques, and time-related...

We analyzed 80 consecutive cases of lumbar disc herniation who underwent an extraperitoneal anterolateral discectomy according to clinical and radiologic parameters. The average follow-up period was 5 1/2 years (range, 1-10 years). The results of 71 patients (89%) were satisfactory through the mid- and long-term follow-up periods, although a very slight decrease in subjective/objective scores and ADL score was found. Satisfactory results were obtained for adolescent and younger male adults and in isolated central or centrolateral herniations with a broad base. From an analysis of the nine reoperated cases, we determined that the contraindications of this technique are a sequestrated or extruded nucleus pulposus and disc protrusion accompanied by posterior dislocation of a vertebral edge fragment. The relative indications include a small, hard posterolateral herniation located just beneath the nerve roots, double-level herniation, disc herniation accompanied by narrow spinal canal, and bulged disc in elder patients. The absolute indications for this surgery are a centrally or centrolaterally protruded disc with a relatively broad base of herniation at single-disc level that is not accompanied by spinal stenosis in adolescent and younger male adults.