title: Combined Interlaminar and Paraisthmic Approach for Co-existing Intracanal and Foraminal Lesion.
abstract: OBJECTIVE
  Stenosis or herniated nucleus pulposus (HNP) occupying lumbar intracanal and foraminal area is an important cause of double radicular symptoms. Using the combined interlaminar and paraisthmic approach, we performed decompression surgery in patients with co-existing intracanal and foraminal lesions. The objective of this study is to describe usefulness and outcome of combined interlaminar and paraisthmic approach surgery and to analysis the cause of poor outcome.
  
  
  METHODS
  Between Apr 2009 and Apr 2014, 78 patients (42 males and 36 females) with intracanal and foraminal lesions were enrolled in this study. Patients with a vacuum disc, spondylolisthesis, instability or an isthmic defect on the preoperative dynamic view radiograph were excluded from this study. All patients underwent surgery through a combined approach for discectomy and decompression. The outcome of surgery was evaluated and classified into excellent, good, fair and poor.
  
  
  RESULTS
  The results were excellent in 53 patients, good in 9, fair in 6 and poor in 10 during the follow-up. The outcome of the combined approach was excellent to fair in 87% (68 of 78) patients in our study. In the poor outcome group, three patients complained of early-onset relapsed pain (<1 month) and another seven patients complained of delayed-onset pain (>3 months).
  
  
  CONCLUSIONS
  Combined approach for both intracanal and foraminal area lesions may be useful if selectively performed on patients whose facet joint is relatively intact, and that it is worthy of consideration as an alternative to fusion surgery; however, further studies are needed.
authors.affiliation: Department of Neurosurgery, Suwon Nanoori Hospital, Suwon-si, Gyeonggi-do, Korea.
authors.forename: Jung-Sup
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Seoul Nanoori Hospital, Seoul, Korea.
authors.forename: Jong-Yun
authors.initials: JY
authors.lastname: Woo
authors.affiliation: Department of Neurosurgery, Suwon Nanoori Hospital, Suwon-si, Gyeonggi-do, Korea.
authors.forename: Jee-Soo
authors.initials: JS
authors.lastname: Jang
authors.affiliation: Department of Neurosurgery, Seoul Nanoori Hospital, Seoul, Korea.
authors.forename: Il-Tae
authors.initials: IT
authors.lastname: Jang
keywords: Lumbar; Radiculopathy; Spinal stenosis
references.citation: Clin Orthop Relat Res. 1989 Jan;(238):56-63
references.pmid: 2521318
references.citation: Acta Neurochir (Wien). 1996;138(8):907-10; discussion 910-1
references.pmid: 8890985
references.citation: J Neurosurg. 1995 Oct;83(4):648-56
references.pmid: 7674015
references.citation: J Bone Joint Surg Am. 2003 Nov;85-A(11):2089-92
references.pmid: 14630835
references.citation: Spine (Phila Pa 1976). 1994 Dec 1;19(23):2667-70 discussion 2671
references.pmid: 7899961
references.citation: Spinal Cord. 2002 Oct;40(10):491-500
references.pmid: 12235530
references.citation: Eur Spine J. 2006 May;15(5):554-8
references.pmid: 15761707
references.citation: Spine (Phila Pa 1976). 1991 Nov;16(11):1312-20
references.pmid: 1750006
references.citation: J Bone Joint Surg Br. 1980 Nov;62-B(4):481-5
references.pmid: 6448861
references.citation: Eur Spine J. 2008 May;17 (5):650-6
references.pmid: 18270753
references.citation: Acta Neurochir (Wien). 1990;105(3-4):124-31
references.pmid: 2275423
references.citation: J Neurosurg. 1974 Aug;41(2):229-34
references.pmid: 4841878
references.citation: J Neurosurg. 1991 May;74(5):754-6
references.pmid: 2013776
references.citation: J Spinal Disord. 1992 Mar;5(1):97-103
references.pmid: 1571619
references.citation: Clin Orthop Relat Res. 1973 Mar-Apr;(91):48-57
references.pmid: 4574067
references.citation: Neurosurgery. 2004 Apr;54(4):939-42; discussion 942
references.pmid: 15046661
references.citation: J Neurosurg. 1995 Oct;83(4):636-40
references.pmid: 7674013
references.citation: J Neurosurg. 2002 Jan;96(1 Suppl):118-21
references.pmid: 11795699