Ribhu T Jha1, Hasan R Syed1, Michael Catalino2, Faheem A Sandhu3. 1. Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA. 2. Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA. 3. Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA. Electronic address: fasandhu@aol.com.
Abstract
BACKGROUND: Upper lumbar disc herniations comprise only 1%-2% of all lumbar disc herniations. Patients exhibit nonspecific signs and symptoms in comparison to predictable radiculopathies, as seen in lower lumbar disc herniations. The unique anatomic characteristics of the upper lumbar spine present several challenges for safe and effective surgical treatment of disc herniations. The authors review the anatomy of the upper lumbar spine, describe a novel approach to upper lumbar disc herniations, and present 3 cases with a focus on clinical outcome and technical pearls. METHODS: Conventional techniques for upper lumbar discectomy require a near complete facetectomy and pars interarticularis resection for adequate bony exposure, possibly leading to spinal destabilization. A tubular retractor system was used to approach upper lumbar disc herniation using a contralateral minimally invasive technique, while completely preserving the facet complex and pars interarticularis. RESULTS: We report 3 cases of minimally invasive discectomy from a contralateral approach. The patients experienced complete resolution of presenting symptoms, and the facet complexes were preserved. All cases were free of complications. CONCLUSION: A contralateral approach to perform a minimally invasive discectomy for paracentral and central upper LDH is a safe, efficient, and effective technique. The approach that we describe in this study preserves the facet complex and may prevent future spinal instability.
BACKGROUND:Upper lumbar disc herniations comprise only 1%-2% of all lumbar disc herniations. Patients exhibit nonspecific signs and symptoms in comparison to predictable radiculopathies, as seen in lower lumbar disc herniations. The unique anatomic characteristics of the upper lumbar spine present several challenges for safe and effective surgical treatment of disc herniations. The authors review the anatomy of the upper lumbar spine, describe a novel approach to upper lumbar disc herniations, and present 3 cases with a focus on clinical outcome and technical pearls. METHODS: Conventional techniques for upper lumbar discectomy require a near complete facetectomy and pars interarticularis resection for adequate bony exposure, possibly leading to spinal destabilization. A tubular retractor system was used to approach upper lumbar disc herniation using a contralateral minimally invasive technique, while completely preserving the facet complex and pars interarticularis. RESULTS: We report 3 cases of minimally invasive discectomy from a contralateral approach. The patients experienced complete resolution of presenting symptoms, and the facet complexes were preserved. All cases were free of complications. CONCLUSION: A contralateral approach to perform a minimally invasive discectomy for paracentral and central upper LDH is a safe, efficient, and effective technique. The approach that we describe in this study preserves the facet complex and may prevent future spinal instability.
Authors: Murray Echt; Ryan Holland; Wenzhu Mowrey; Phillip Cezayirli; Rafael De la Garza Ramos; Mousa Hamad; Yaroslav Gelfand; Michael Longo; Merritt D Kinon; Vijay Yanamadala; Saad Chaudhary; Samuel K Cho; Reza Yassari Journal: Global Spine J Date: 2020-08-03