A transfacet approach to the lumbar nerve root canal: technical note

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Lumbar radiculopathy often results from intraforaminal and extraforaminal nerve root compression due to disk herniation or stenosis.
• Current surgical options include spinal canal decompression or lateral decompression via the Wiltse approach.

Purpose of the Study:

• To introduce and evaluate a novel transosseous approach for accessing the lumbar nerve root canal.

Main Methods:

• Transfacet foraminotomy was performed on 11 patients with intraforaminal or extraforaminal disk herniation.
• Outcomes were assessed using the Patient Satisfaction Index (PSI), reoperation rates, radiographic analysis, and finite element analysis.

Main Results:

• High patient satisfaction was observed, with 10 patients reporting a PSI score of 1 or 2 at the last follow-up.
• Two patients required reoperation for recurrent disk herniation.
• Postoperative CT scans demonstrated significant shrinkage of the facet joint hole within one month, indicating joint preservation.

Conclusions:

• The posterior-anterior transfacet approach with ellipsoid facetectomy is a safe and effective method for decompressing lumbar nerve roots.
• This technique provides fast and comfortable decompression without compromising the long-term stability of the facet joint.