Transtubular microsurgical approach to treating extraforaminal lumbar disc herniations
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Transtubular microsurgical approach to treating extraforaminal lumbar disc herniations. / Eicker, Sven O; Rhee, Sascha; Steiger, Hans-Jakob; Herdmann, Jörg; Floeth, Frank W.
In: NEUROSURG FOCUS, Vol. 35, No. 2, 08.2013, p. E1.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Transtubular microsurgical approach to treating extraforaminal lumbar disc herniations
AU - Eicker, Sven O
AU - Rhee, Sascha
AU - Steiger, Hans-Jakob
AU - Herdmann, Jörg
AU - Floeth, Frank W
PY - 2013/8
Y1 - 2013/8
N2 - OBJECT: Approaches to treating extraforaminal lumbar disc herniations can be challenging due to the unique anatomy and the need to prevent spinal instability. Numerous approaches, including conventional midline, paramedian, minimally invasive, and full endoscopic approaches, have been described. The purposes of this study were to point out the outcome and clinical advantages of a transtubular microsurgical approach and to describe and illustrate this technique.METHODS: Between 2009 and 2012, a series of 51 patients underwent a minimally invasive dilative transtubular microsurgical approach for the treatment of extraforaminal lumbar disc herniations. All patients were clinically evaluated using the visual analog scale (VAS) and Oswestry Disability Index preoperatively and 6 months postoperatively.RESULTS: Both pain scores and functional status showed significant improvement after surgery (p < 0.001): radicular pain decreased from VAS score of 7.9 to one of 1.3, lower back pain from VAS score of 2.4 to 1.4, and the Oswestry Disability Index from 42.0 to 12.3. Subgroup analyses revealed no differences in outcome regarding obesity or timing of surgery (early vs late intervention). Highly significant was the correlation between preoperative radicular pain activity and timing of surgical intervention (p < 0.001).CONCLUSIONS: The dilative transtubular microsurgical approach combines the advantages of the conventional open muscle-splitting approach and the endoscopic approach. The technique is easy to use with a steep learning curve. Less muscle trauma and the absence of bony resection prevent facet pain and instability, thereby contributing to a rapid recovery. Patients in this series improved excellently in the short-term follow-up.
AB - OBJECT: Approaches to treating extraforaminal lumbar disc herniations can be challenging due to the unique anatomy and the need to prevent spinal instability. Numerous approaches, including conventional midline, paramedian, minimally invasive, and full endoscopic approaches, have been described. The purposes of this study were to point out the outcome and clinical advantages of a transtubular microsurgical approach and to describe and illustrate this technique.METHODS: Between 2009 and 2012, a series of 51 patients underwent a minimally invasive dilative transtubular microsurgical approach for the treatment of extraforaminal lumbar disc herniations. All patients were clinically evaluated using the visual analog scale (VAS) and Oswestry Disability Index preoperatively and 6 months postoperatively.RESULTS: Both pain scores and functional status showed significant improvement after surgery (p < 0.001): radicular pain decreased from VAS score of 7.9 to one of 1.3, lower back pain from VAS score of 2.4 to 1.4, and the Oswestry Disability Index from 42.0 to 12.3. Subgroup analyses revealed no differences in outcome regarding obesity or timing of surgery (early vs late intervention). Highly significant was the correlation between preoperative radicular pain activity and timing of surgical intervention (p < 0.001).CONCLUSIONS: The dilative transtubular microsurgical approach combines the advantages of the conventional open muscle-splitting approach and the endoscopic approach. The technique is easy to use with a steep learning curve. Less muscle trauma and the absence of bony resection prevent facet pain and instability, thereby contributing to a rapid recovery. Patients in this series improved excellently in the short-term follow-up.
KW - Adult
KW - Aged
KW - Diskectomy, Percutaneous
KW - Female
KW - Humans
KW - Intervertebral Disc Displacement
KW - Learning Curve
KW - Magnetic Resonance Imaging
KW - Male
KW - Microsurgery
KW - Middle Aged
KW - Pain Measurement
KW - Retrospective Studies
KW - Treatment Outcome
U2 - 10.3171/2013.4.FOCUS13126
DO - 10.3171/2013.4.FOCUS13126
M3 - SCORING: Journal article
C2 - 23905947
VL - 35
SP - E1
JO - NEUROSURG FOCUS
JF - NEUROSURG FOCUS
SN - 1092-0684
IS - 2
ER -