title: Navigated Transtubular Extraforaminal Decompression of the L5 Nerve Root at the Lumbosacral Junction: Clinical Data, Radiographic Features, and Outcome Analysis.
abstract: Purpose. Extraforaminal decompression of the L5 nerve root remains a challenge due to anatomic constraints, severe level-degeneration, and variable anatomy. The purpose of this study is to introduce the use of navigation for transmuscular transtubular decompression at the L5/S1 level and report on radiological features and clinical outcome. Methods. Ten patients who underwent a navigation-assisted extraforaminal decompression of the L5 nerve root were retrospectively analyzed. Results. Six patients had an extraforaminal herniated disc and four had a foraminal stenosis. The distance between the L5 transverse process and the para-articular notch of the sacrum was 12.1 mm in patients with a herniated disc and 8.1 mm in those with a foraminal stenosis. One patient had an early recurrence and another developed dysesthesia that resolved after 3 months. There was a significant improvement from preoperative to postoperative NRS with the results being sustainable at follow-up. ODI was also significantly improved after surgery. According to the Macnab grading scale, excellent or good outcomes were obtained in 8 patients and fair ones in 2. Conclusions. The navigated transmuscular transtubular approach to the lumbosacral junction allows for optimal placement of the retractor and excellent orientation particularly for foraminal stenosis or in cases of complex anatomy.
authors.affiliation: Department of Neurosurgery, University Hospital of Cologne, 50937 Cologne, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Stavrinou
authors.affiliation: Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10021, USA.
authors.forename: R
authors.initials: R
authors.lastname: Härtl
authors.affiliation: Department of Neurosurgery, University Hospital of Cologne, 50937 Cologne, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Krischek
authors.affiliation: Department of Radiology and Neuroradiology, University Hospital of Cologne, 50937 Cologne, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kabbasch
authors.affiliation: Department of Radiology and Neuroradiology, University Hospital of Cologne, 50937 Cologne, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Mpotsaris
authors.affiliation: Department of Neurosurgery, University Hospital of Cologne, 50937 Cologne, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Goldbrunner
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging* / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D013127:Spinal Nerves / Q000601:surgery*; D013130:Spinal Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome