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Lumbar Giant Disk Herniations Treated With a Unilateral Approach for Bilateral Decompression
Fabian Sommer1, Lynn McGrath, Sertac Kirnaz
1Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA.
Operative Neurosurgery (Hagerstown, Md.)
|June 21, 2022
Summary
Minimally invasive tubular surgery is a safe and effective option for giant disk herniations (GDHs). This approach, with modifications for bilateral decompression, successfully treated patients with severe symptoms and cauda equina syndrome.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Minimally Invasive Procedures
Background:
- Giant disk herniations (GDHs) (>50% spinal canal obstruction) pose surgical challenges due to size and risk of neurological compromise.
- The efficacy of minimally invasive tubular approaches for lumbar GDHs remains debated.
Purpose of the Study:
- To evaluate the safety and effectiveness of tubular minimally invasive surgery for treating lumbar GDHs.
Main Methods:
- Modified standard tubular diskectomy with unilateral laminectomy for bilateral decompression.
- Assessment of neurological deficits, pain (Visual Analog Scale), operating time, complications, blood loss, and revisions in 23 GDH patients.
Main Results:
- 23 patients (10%) met GDH criteria, with 91.3% having motor weakness and 13% presenting with cauda equina syndrome.
- Preoperative pain (VAS 8.3) significantly reduced to 2.4 post-surgery.
- All cauda equina syndrome cases resolved postoperatively.
Conclusions:
- Unilateral tubular minimally invasive diskectomy with "over-the-top" decompression is a safe and effective treatment for lumbar GDHs.
- This technique provides adequate working space and bilateral decompression, improving patient outcomes.
