Management of disc herniations with bi-radicular symptoms via combined lateral and interlaminar approach.
Large lumbosacral disc herniations causing bi-radicular symptoms are very rare clinical entities and may present a surgical challenge. This study was undertaken to evaluate the effectiveness of the simply modified combined lateral and interlaminar approach for the treatment of these unique disc herniations. Between 2000 and 2005, 18 patients with bi-radicular symptoms secondary to large disc herniations of the lumbar spine underwent surgery. There were 13 men and five women, ranging in age between 25 and 64 years (mean 54.3 years). In this three-step operation, the osseous areas that are not essential for the facet joint were removed and both upper and lower nerve roots were decompressed. There were no intraoperative or postoperative complications, except transient dysesthesia in one (5.5%) patient. The mean follow-up period was 62.6 months (range 36-96 months). At the latest follow-up examination, outcomes using the Macnab classification were excellent in 13 patients (72.2 %), good in four (22.2%) and fair in one (5.5%). Recurrent disc herniations and/or instability, either symptomatic or radiographic, have not occurred as a result of the procedure during the follow-up period. The combined approach described here is a safe and effective procedure in the surgical treatment of this subtype of disc herniations with bi-radicular involvement. It permits optimum decompression of both nerve roots, avoiding the risk of secondary spinal instability.
Kutlay
Murat
M
GATA Haydarpaşa Eğitim Hastanesi, Nöroşirürji Servisi, Usküdar, 34668 Istanbul, Turkey.
Topuz
Kivanç
K
Colak
Ahmet
A
Simşek
Hakan
H
Cetinkal
Ahmet
A
Demircan
Mehmet Nusret
MN
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D007593:Joint Instability / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D019635:Neurosurgical Procedures; D010146:Pain / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D013126:Spinal Nerve Roots / Q000601:surgery; D016896:Treatment Outcome
J Bone Joint Surg Am. 1971 Jul;53(5):891-903
4326746
J Neurosurg. 1996 Mar;84(3):462-7
8609559
Spine (Phila Pa 1976). 1993 Aug;18(10):1263-7
8211356
J Neurosurg. 1991 May;74(5):754-6
2013776
Spinal Cord. 2002 Oct;40(10):491-500
12235530
Neurosurg Rev. 1992;15(4):255-8
1480271
Surg Neurol. 1998 Jun;49(6):588-97; discussion 597-8
9637618
J Bone Joint Surg Br. 1998 Mar;80(2):201-7
9546444
J Neurosurg. 2002 Mar;96(2 Suppl):206-11
12450284
Eur Spine J. 2006 May;15(5):554-8
15761707
J Neurosurg. 1999 Jan;90(1 Suppl):59-66
10413127
Spine (Phila Pa 1976). 1991 Nov;16(11):1312-20
1750006
Spine (Phila Pa 1976). 1999 Jun 15;24(12):1243-6
10382252
Nervenarzt. 1983 Oct;54(10):521-4
6646290
Acta Neurochir (Wien). 1989;99(1-2):58-60
2756851
Spine (Phila Pa 1976). 1994 Dec 1;19(23):2667-70 discussion 2671
7899961
Acta Neurochir (Wien). 1987;84(1-2):64-7
3825610
Neurosurgery. 1988 Apr;22(4):648-53
3374776
J Neurosurg. 2002 Jan;96(1 Suppl):118-21
11795699
Neurosurg Clin N Am. 1993 Jan;4(1):117-24
8428146
Acta Neurochir (Wien). 1989;100(1-2):3-11
2816531
J Neurosurg. 1990 Mar;72(3):378-82
2303871
Neurosurgery. 1998 Jan;42(1):87-9; discussion 89-90
9442508
J Neurosurg. 1990 Jan;72(1):143-4
2294175
Spine (Phila Pa 1976). 1988 Jun;13(6):696-706
3175760
Spine (Phila Pa 1976). 1992 Mar;17(3):363-5
1566174
J Neurosurg. 1995 Oct;83(4):648-56
7674015
Neurosurgery. 1996 Aug;39(2):345-50; discussion 350-1
8832672
J Neurosurg. 1995 Oct;83(4):636-40
7674013
Acta Neurochir (Wien). 1996;138(8):907-10; discussion 910-1
8890985
Acta Neurochir (Wien). 1992;118(3-4):117-29
1456095
J Bone Joint Surg Am. 1968 Jul;50(5):919-26
5676831
Neurochirurgie. 1985;31(1):61-4
4000363
Br J Neurosurg. 1987;1(1):111-29
3267271
J Spinal Disord. 1992 Mar;5(1):97-103
1571619
Acta Neurochir (Wien). 1989;99(1-2):51-7
2526990
Neurosurgery. 1998 Oct;43(4):854-61; discussion 861-2
9766313
Spine (Phila Pa 1976). 1984 Jan-Feb;9(1):49-52
6719256
Spine (Phila Pa 1976). 1995 Jul 1;20(13):1500-5
8623070
Acta Neurochir (Wien). 1990;105(3-4):124-31
2275423
Spine (Phila Pa 1976). 1994 Dec 1;19(23):2707-14
7899968