title: Microsurgical midline approach for the decompression of extraforaminal stenosis in L5-S1.
abstract: OBJECTIVE
  When performing surgery, the extraforaminal window is very narrow at the L5-S1 level. The authors describe a microsurgical method for decompression of the L-5 nerve root trapped between a marginal osteophyte of the vertebral body and the transverse process. The procedure was performed in 16 patients with extraforaminal stenosis.
  
  
  METHODS
  The cranial part of the L5-S1 facet joint and the caudal portion of the pedicle and transverse process of L-5 were removed via a midline skin incision and partial resection of the pars interarticularis; a high-speed drill was used as was a surgical microscope. The affected nerve root was decompressed and mobilized cranially. Postoperatively all patients reported excellent relief of their sciatic pain, and there were no technique-associated complications. There was no recurrence during the follow-up period, that ranged from 14 to 70 months.
  
  
  CONCLUSIONS
  The authors recommend this technique for the effective decompression of symptomatic extraforaminal L5-S1 stenosis. The need for a dangerous and tedious removal of the vertebral osteophyte together with spinal fusion is avoided.
authors.affiliation: Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea. ykapa@kumc.or.kr
authors.forename: Youn-Kwan
authors.initials: YK
authors.lastname: Park
authors.forename: Joo Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Hung Seob
authors.initials: HS
authors.lastname: Chung
authors.forename: Jung Keun
authors.initials: JK
authors.lastname: Suh
mesh_terms: D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011843:Radiculopathy / Q000601:surgery*; D011859:Radiography; D012447:Sacrum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013126:Spinal Nerve Roots / Q000473:pathology / Q000601:surgery*; D013130:Spinal Stenosis / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome