The minimally invasive paramedian approach for foraminal disc herniation

• Published in: Journal of clinical neuroscience 2020-05, Vol.75, p.62-65
• Main Authors: Verla, Terence, Goethe, Eric, Srinivasan, Visish M., Winnegan, Lona, Omeis, Ibrahim
• Format: Article
• Language: English
• Subjects: Foraminal disc herniation; Microdiscectomy; Minimally invasive; Paramedian approach
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2020.03.029

•The paramedian approach to foraminal disc herniation produces satisfactory clinical and functional outcomes.•Approach involved hemilaminectomy, partial medial pars resection, medial facetectomy and microdiscectomy.•Low complication rate and most patients discharged home the same day of surgery.•Outcomes comparable to other studies and approaches to symptomatic foraminal disc herniation. Foraminal disc herniation presents with an operative challenge, as it often requires facetectomy, which can result in segmental instability. The intraforaminal approach includes partial pars resection and medial facetectomy and allows for direct visualization of the nerve roots and herniated disc in the foramen without violating the joint, with good clinical outcomes. Herein, we describe a retrospective series of patients that underwent minimally invasive paramedian approach with hemilaminectomy, partial medial pars resection, medial facetectomy for foraminal disc herniation. Demographics and clinical outcomes were obtained from medical records. Improvement in functional outcomes was evaluated using the pre and post-operative Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). A total of 23 patients were included in this study. The average age was 56.47 ± 9.4 yrs and body mass index was 31.92 ± 7.7 kg/m2. 47.8% of cases were L4-5 FDH. The estimated blood loss was 31.32 ± 19.8 ml. The average length of hospital stay was 1.11 ± 0.3 days. All patients were discharged home. Overall, there was a significant improvement in the VAS (pre-op: 8.21 ± 2.1; post-op: 2.59 ± 2.7; p-value: