Contralateral approach for minimally invasive treatment of upper lumbar intervertebral disc herniation: technical note and case series

• Published in: World neurosurgery 2017-04, Vol.100, p.583-589
• Main Authors: Jha, Ribhu T., MD, Syed, Hasan R., MD, Catalino, Michael, MD, Sandhu, Faheem A., MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Combined Modality Therapy - methods; Contralateral approach; Discectomy; Diskectomy - methods; Female; Humans; Intervertebral Disc Displacement - complications; Intervertebral Disc Displacement - diagnostic imaging; Intervertebral Disc Displacement - surgery; Laminectomy - methods; Lumbar Vertebrae - surgery; Male; Middle Aged; Minimally invasive; Minimally Invasive Surgical Procedures - methods; Neurosurgery; Spinal Cord Compression - diagnosis; Spinal Cord Compression - etiology; Spinal Cord Compression - surgery; Treatment Outcome; Upper lumbar discectomy
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.01.059

Abstract Background Upper lumbar disc herniations comprise only 1 to 2% of all lumbar disc herniations. Patients present with non-specific signs and symptoms in comparison to predictable radiculopathies as seen in lower lumbar disc herniations. The unique anatomical 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 three 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 via a contralateral minimally invasive technique, while completely preserving the facet complex and pars interarticularis. Results We report three 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.