Transpars approach for L5-S1 foraminal and extra-foraminal lumbar disc herniations: technical note.

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Spine Surgery

Background:

• Far lateral L5-S1 disc herniations present surgical challenges due to narrow corridors.
• The transpars approach is technically demanding in this region.

Purpose of the Study:

• To evaluate the feasibility, efficacy, and safety of the transpars microscopic approach.
• To assess its application in treating L5-S1 foraminal and extraforaminal lumbar disc herniation.

Main Methods:

• Prospective study of 14 patients with L5-S1 far lateral lumbar disc herniation from 2015-2019.
• Data collected included pain scores (NRS), Oswestry Disability Index, nerve-root palsy, and Macnab criteria.
• Follow-up included clinical assessments and lumbar dynamic X-rays up to 4 years.

Main Results:

• Significant improvements in leg (NRS-leg) and back (NRS-back) pain scores (P<0.0001).
• Oswestry Disability Index significantly decreased (P<0.0001), with 85.7% achieving excellent/good outcomes (Macnab criteria).
• All patients with L5 root palsy improved, and all non-retired patients returned to work within 30 days. No recurrence or re-operations.

Conclusions:

• The transpars microscopic approach is feasible, safe, and effective for L5-S1 foraminal and extraforaminal disc herniation.
• Optimal surgical technique involves an oblique, caudally directed working angle parallel to the L5 pedicle.
• The iliac crest is not a significant surgical impediment.