Surgical therapy of intraforaminal/extraforaminal lumbar disc herniations: Many approaches for few surgical routes.
Acta Neurochir (Wien). 2017 Jul;159(7):1273-1281
Authors: Lofrese G, Mongardi L, Cultrera F, Trapella G, De Bonis P
BACKGROUND: A number of disc illness nomenclatures and approaches for LDH exist. The standard midline bone-destructive procedures along with approaches requiring excessive muscular retraction are being changed by muscle sparing, focused, stability-preserving surgical routes. The rising hypothesis on LDHs and the modern corridors described to deal with them have lead to an intensive manufacturing of papers steadily treating the identical subject however adopting totally different terminologies and reporting contradictory outcomes.
METHODS: The evaluate of such literature one way or the other confounding gave us the possibility to regroup by surgical corridors the huge quantity of approaches for LDH otherwise renamed over time. Likewise, LDHs had been simplified in intra-foraminal (ILDH), extra-foraminal (ELDH), and intra-/extra-foraminal (IELDH) in relation to specific anatomical boundaries and extent of bulging disc.
RESULTS: By way of the evaluation of the papers, it was doable to determine preferrred surgical corridors for ILDHs, ELDHs, and IELDHs, distinguishing for every strategy the publicity offered and the technical benefits/disadvantages by way of muscle trauma, biomechanical stability, and nerve root preservation. A big disproportion was famous between research discussing conventional midline approaches or variants of the posterolateral route and people investigating execs and cons of straightforward or mixed different corridors. Though not often mentioned, these latter characterize beneficial methods significantly for the difficult IELDHs, because of the optimum compromise between herniation publicity and bone-muscle preservation.
CONCLUSIONS: The combination of satisfactory mastery of conventional approaches along with a higher confidence by way of unfamiliar surgical corridors can enhance the event of mixed mini-invasive procedures, which appear promising for future focused LDH excisions.
PMID: 28534073 [PubMed – indexed for MEDLINE]