Far lateral disc prolapse accounts for 6.5% to 12% of all lumbar disc prolapses. Surgical options include open laminectomy with discectomy, microscopic and endoscopic excision of the prolapsed disc. Some of these opti...Far lateral disc prolapse accounts for 6.5% to 12% of all lumbar disc prolapses. Surgical options include open laminectomy with discectomy, microscopic and endoscopic excision of the prolapsed disc. Some of these options may not be available in limited resources centers. We will highlight the effectiveness of various surgical options. Twenty patients with foraminal and extraforaminal lumbar disc prolapse were operated upon from January, 2015 to June, 2016 in the neurosurgical departments of Cairo and Fayoum Universities in Egypt by different modalities (open laminectomy with discectomy, microscopic and endoscopic discectomy). Seventeen patients had foraminal disc prolapse and only three patients had extraforaminal disc prolapse. Twelve patients were operated by conventional laminectomy approach. Microscope was used in four patients and four patients were operated endoscopically. Excellent radicular pain improvement was achieved in 15 cases (75%) including all of the laminectomy groups. Conventional laminectomy and discectomy in far lateral disc prolapse remains an excellent option especially in limited resources centers. Although building up experience with other surgical modalities is mandatory.展开更多
Background Far lateral lumbar disc herniation （FLLDH） accounts for 2.6% to 11.7% of all lumbar herniated discs. Numerous surgical approaches have been described for treating this condition. The purpose of this study...Background Far lateral lumbar disc herniation （FLLDH） accounts for 2.6% to 11.7% of all lumbar herniated discs. Numerous surgical approaches have been described for treating this condition. The purpose of this study was to evaluate minimally invasive surgical techniques for the treatment of FLLDH. Methods From June 2000 to March 2006, 52 patients with FLLDH were treated with minimally invasive procedures. All patients were assessed by anteroposterior and lateral roentgenography and computed tomography （CT）. Some patients underwent myelography, discography, and magnetic resonance imaging. Procedures performed included Yeung Endoscopy Spine System （YESS） （n=25）, METRx MicroDiscectomy System （n=13）, and X-tube （n=14）. Patients were followed up for a mean of 13.5 months. Clinical outcomes were assessed using a visual analog scale （VAS） and Nakai criteria. Results All 3 procedures significantly improved radiating leg symptoms （P 〈0.005）. After surgery, 84.0%, 84.6%, and 92.8% of patients in the YESS, METRx, and X-tube groups had excellent or good outcomes. There were no statistically significant differences of VAS scores between the groups. The YESS procedure was associated with the shortest operation time, simplest anesthesia, and least trauma compared with the other 2 procedures, especially for type I herniations. The METRx procedure was the most suitable for type Ⅱ herniations and posterior endoscopic facetectomy. Posterior lumbar interbody fusion and unilateral pedicle screw instrumentation with X-tube was the most suitable for herniations combined with degenerative lumbar instability （type Ⅲ）. Conclusion Minimally invasive strategies and options should be determined with reference to the type of FLLDH.展开更多
文摘Far lateral disc prolapse accounts for 6.5% to 12% of all lumbar disc prolapses. Surgical options include open laminectomy with discectomy, microscopic and endoscopic excision of the prolapsed disc. Some of these options may not be available in limited resources centers. We will highlight the effectiveness of various surgical options. Twenty patients with foraminal and extraforaminal lumbar disc prolapse were operated upon from January, 2015 to June, 2016 in the neurosurgical departments of Cairo and Fayoum Universities in Egypt by different modalities (open laminectomy with discectomy, microscopic and endoscopic discectomy). Seventeen patients had foraminal disc prolapse and only three patients had extraforaminal disc prolapse. Twelve patients were operated by conventional laminectomy approach. Microscope was used in four patients and four patients were operated endoscopically. Excellent radicular pain improvement was achieved in 15 cases (75%) including all of the laminectomy groups. Conventional laminectomy and discectomy in far lateral disc prolapse remains an excellent option especially in limited resources centers. Although building up experience with other surgical modalities is mandatory.
文摘Background Far lateral lumbar disc herniation （FLLDH） accounts for 2.6% to 11.7% of all lumbar herniated discs. Numerous surgical approaches have been described for treating this condition. The purpose of this study was to evaluate minimally invasive surgical techniques for the treatment of FLLDH. Methods From June 2000 to March 2006, 52 patients with FLLDH were treated with minimally invasive procedures. All patients were assessed by anteroposterior and lateral roentgenography and computed tomography （CT）. Some patients underwent myelography, discography, and magnetic resonance imaging. Procedures performed included Yeung Endoscopy Spine System （YESS） （n=25）, METRx MicroDiscectomy System （n=13）, and X-tube （n=14）. Patients were followed up for a mean of 13.5 months. Clinical outcomes were assessed using a visual analog scale （VAS） and Nakai criteria. Results All 3 procedures significantly improved radiating leg symptoms （P 〈0.005）. After surgery, 84.0%, 84.6%, and 92.8% of patients in the YESS, METRx, and X-tube groups had excellent or good outcomes. There were no statistically significant differences of VAS scores between the groups. The YESS procedure was associated with the shortest operation time, simplest anesthesia, and least trauma compared with the other 2 procedures, especially for type I herniations. The METRx procedure was the most suitable for type Ⅱ herniations and posterior endoscopic facetectomy. Posterior lumbar interbody fusion and unilateral pedicle screw instrumentation with X-tube was the most suitable for herniations combined with degenerative lumbar instability （type Ⅲ）. Conclusion Minimally invasive strategies and options should be determined with reference to the type of FLLDH.
