Extraperitoneal anterolateral discectomy for lumbar disc herniation: indications, techniques, and time-related clinical results.
We analyzed 80 consecutive cases of lumbar disc herniation who underwent an extraperitoneal anterolateral discectomy according to clinical and radiologic parameters. The average follow-up period was 5 1/2 years (range, 1-10 years). The results of 71 patients (89%) were satisfactory through the mid- and long-term follow-up periods, although a very slight decrease in subjective/objective scores and ADL score was found. Satisfactory results were obtained for adolescent and younger male adults and in isolated central or centrolateral herniations with a broad base. From an analysis of the nine reoperated cases, we determined that the contraindications of this technique are a sequestrated or extruded nucleus pulposus and disc protrusion accompanied by posterior dislocation of a vertebral edge fragment. The relative indications include a small, hard posterolateral herniation located just beneath the nerve roots, double-level herniation, disc herniation accompanied by narrow spinal canal, and bulged disc in elder patients. The absolute indications for this surgery are a centrally or centrolaterally protruded disc with a relatively broad base of herniation at single-disc level that is not accompanied by spinal stenosis in adolescent and younger male adults.
Tsuji
H
H
Department of Orthopaedic Surgery, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Japan.
Hirano
N
N
Ohshima
H
H
Matsui
H
H
Ishihara
H
H
Imada
K
K
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods; D012086:Reoperation; D013126:Spinal Nerve Roots