title: Transarticular laser discal fragmentectomy. A new minimally invasive surgical approach for challenging disc herniations in the elderly.
abstract: This report describes two elderly patients with large disc fragments extruded into lumbar radicular recesses not treatable by any conventional conservative, minimally invasive or surgical approach. Direct access to the disc fragments was obtained crossing the articular zygapophyseal cavity instead of the interlaminar space and spinal canal, using a small needle through which a laser fibre was inserted to deliver energy for tissue ablation. The procedures obtained regression of both symptoms and the bulk of the fragments at early and late clinical and MR follow-ups.
authors.affiliation: Neuroradiology Department, Papa Giovanni XXIII Hospital; Bergamo, Italy - bbonaldi@yahoo.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bonaldi
authors.affiliation: Neurosurgery Department, Papa Giovanni XXIII Hospital; Bergamo, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Brembilla
authors.affiliation: Neurophysiology Department, Papa Giovanni XXIII Hospital; Bergamo, Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Foresti
authors.affiliation: Neuroradiology Department, Neurocenter of Italian Switzerland; Lugano, Switzerland.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cianfoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D002358:Cartilage, Articular / Q000601:surgery; D004576:Electromyography; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D064795:Intraoperative Neurophysiological Monitoring; D053685:Laser Therapy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000601:surgery; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: disc herniation; laser; percutaneous disc decompression