Translaminar approach to cranio-laterally herniated lumbar disc prolapse

For cranio-laterally extruded disc fragments, a far enlargement of the standard interlaminar fenestration is necessary. This strategy harbours a potential risk for relevant destruction of the facet joints and postsurgical instability could be the consequence. For preserving the facet joint, a limited approach through the hemilamina is possible.

After the standard paramedian soft tissue approach and retraction of the paravertebral muscles laterally, the hemilamina is exposed and fenestrated, preserving the bony borders of the lamina. The disc herniation can be extracted via this lamina fenestration.

This surgical strategy is safe and effective in approaching cranially herniated disc fragments.