title: Disc Fragment Herniectomy Through a Facet Joint Quadrantectomy for Extraforaminal Lumbar Herniation: Technique and Results.
abstract: BACKGROUND
  Extraforaminal lumbar disc herniation (EFLDH) accounts for 7%-12% of all lumbar disc herniations. We report on a surgical technique for EFLDH, which requires only minimal resection of the facet joint and also allows access to the preforaminal space, if necessary.
  
  
  METHODS
  The medical records of 61 consecutive patients treated with disc fragment herniectomy through a facet joint quadrantectomy for EFLDH at the Universitair Ziekenhuis Brussel were critically evaluated with respect to preoperative clinical signs and symptoms, surgery-related complications and outcome at 6 weeks after intervention. Patient satisfaction after the surgery was evaluated using the MacNab classification.
  
  
  RESULTS
  The prevalence of leg pain decreased from 100% before the intervention to 19.7% at follow-up. Only 9 patients (14.8%) suffered from residual motor deficit at follow-up, compared with 37 patients (60.7%) in the preoperative situation. The postoperative improvement was highly significant for all parameters (P < 0.0001) and this evolution is also reflected in the MacNab classification showing 62.3% excellent, 23.0% good, 13.1% fair, and only 1.6% poor satisfaction. Using logistic regression analysis, only the presence of a preoperative sensory deficit was found to be an independent predictor for excellent patient satisfaction on the MacNab classification.
  
  
  CONCLUSIONS
  Disc fragment herniectomy through a facet joint quadrantectomy for EFLDH is a safe and minimal invasive technique resulting in very satisfactory results. Preservation of facet joint stability and the possibility to convert to a classic approach to reach for preforaminal components, if necessary, are major advantages of this technique.
authors.affiliation: Department of Neurosurgery, UZ Brussel, and Center for Neuroscience (C4N), Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Laurens
authors.initials: L
authors.lastname: Dereymaeker
authors.affiliation: Department of Neurology, UZ Brussel, and Center for Neuroscience (C4N), Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Raf
authors.initials: R
authors.lastname: Brouns
authors.affiliation: Department of Neurosurgery, UZ Brussel, and Center for Neuroscience (C4N), Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Herregodts
authors.affiliation: Department of Neurology, ZNA Middelheim General Hospital, Antwerp, Belgium; Department of Clinical and Experimental Neurolinguistics, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Mariën
authors.affiliation: Department of Neurology, UZ Brussel, and Center for Neuroscience (C4N), Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: De Smedt
authors.affiliation: Department of Neurosurgery, UZ Brussel, and Center for Neuroscience (C4N), Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Mike
authors.initials: M
authors.lastname: Huylebrouck
authors.affiliation: Department of Neurosurgery, UZ Brussel, and Center for Neuroscience (C4N), Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Johnny
authors.initials: J
authors.lastname: Duerinck
authors.affiliation: Department of Neurosurgery, UZ Brussel, and Center for Neuroscience (C4N), Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: D'Haens
authors.affiliation: Department of Neurosurgery, UZ Brussel, and Center for Neuroscience (C4N), Vrije Universiteit Brussel, Brussels, Belgium. Electronic address: mtmoens@gmail.com.
authors.forename: Maarten
authors.initials: M
authors.lastname: Moens
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery*; D007796:Laminectomy / Q000379:methods; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012447:Sacrum / Q000601:surgery*; D021801:Zygapophyseal Joint / Q000601:surgery
keywords: Extraforaminal; Facet joint quadrantectomy; Lumbar disc herniation