LATERAL MICROSURGICAL APPROACH PERFORMED WITH MEDIAN INCISION WITHOUT OPENING INTERTRANSVERSE FASCIA FOR PATIENTS WITH L5-S1 FAR LATERAL DISC HERNIATION: A RETROSPECTIVE EVALUATION OF 12 PATIENTS

Abstract

Objective: HL5-S1 far lateral lumbar disc herniations (FLLDH) are extremely rare disc pathologies and herniated disc is located on the lateral side of the pedicle. The aim of this study is to evaluate 12 patients suffering from L5-S1 FLLDH who were operated on using/via the lateral interpedicular microsurgical approach and to discuss in the context of the current literature. Material and Methods: 12 patients (5 male and 7 females) with L5-S1 FLLDH partcicpated/participated in this study. All patients were operated on between the year 2015 and 2017 at the same medical center using the lateral interpedicular microsurgical approach. After the midline skin incision, thoracolumbar fascia was opened at the side of the herniation, a subperiosteal dissection of paravertebral muscles was carried out and Taylor retractors were placed. Subsequently, minimal amounts of bone were removed from the fascet joints and pars interarticularis, the exiting nerve root was explored at the lateral of the pars interarticularis and a microsurgical removal of herniation was performed. Results: The mean visual analog scores (VAS) decreased from 9.25±0.75 to 0.76±0.75 postoperatively and the difference between the preoperative and postoperative VAS scores was statistically significant (p=0.0001). 6 months after surgery 5 patients were graded as excellent (41.7%), 6 patients were good (50%) and 1 patient was fair (8.3%) according to the MacNab classification. Conclusion: The lateral interpedicular microsurgical approach with median incision without opening intertransverse fascia is a safe, easy and minimally invasive technique for the surgical treatment of L5-S1 FLLDH. 

Keywords

• L5-S1 far lateral,Microsurgical approach,Minimally invasive

L5-S1 FAR LATERAL DİSK HERNİASYONLU HASTALAR İÇİN İNTERTRANSVERS FASYA AÇILMADAN MEDİAN İNSİZYON İLE GERÇEKLEŞTİRİLEN LATERAL MİKROŞİRÜRJİKAL YAKLAŞIM: 12 HASTANIN RETROSPEKTİF DEĞERLENDİRİLMESİ

Abstract

Amaç: L5-S1 far lateral lumbar disk herniasyonları (FLLDH) nadir görülen disk patolojileridir. FLLDH’nda disk materyali pedikülün lateralindedir. Bu çalışmanın amacı; lateral interpediküler mikroşirürjikal yaklaşımla opere edilen L5-S1 FLLDH’lu 12 hastanın retrospektif olarak değerlendirilip güncel literatür eşliğinde tartışılmasıdır. Gereç ve Yöntem: Çalışmamıza L5-S1 far lateral alana ve foramene uzanım gösteren, radikülopatiye neden olan ekstrüde veya sekestre disk herniasyonları dahil edilmiştir. Orta hat cilt insizyonu ile torakolomber fasyanın orta hattan açılması, paravertebral adelelerin subperiostal sıyrılarak pars lateralinde exiting kökün açığa konulması, far lateral kompartımanda sekestre veya ekstrüde disk fragmanlarının alınması hedeflenmiştir. Bulgular: Ameliyat öncesi VAS değeri 9,25±0,75’lerden 0,76±0,75 değerlerine geriledi. Ameliyat öncesi ve sonrası VAS skor ortalamaları birbirinden anlamlı derecede farklıydı (p=0,0001). MacNab sınıflamasına göre 6 ay sonraki postoperatif sonuçlar; 5 hasta mükemmel (%41,7), 6 hasta iyi (%50) ve 1 hasta orta derecede memnun (%8,3) şeklindeydi. Sonuç: İntertransvers fasya açılmadan median insizyon ile yapılan lateral interpediküler mikroşirürjikal yaklaşım, L5-S1 FLLDH’nın cerrahi tedavisi için uygulanabilirliği kolay, operasyon süresi kısa, komplikasyon oranı düşük, güvenli minimal invazif bir yöntemdir.

Keywords

• L5-S1 far lateral,Lateral mikroşirürjikal yaklaşım,Lomber disk herniasyonu

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