title: Contralateral interlaminar approach for intraforaminal lumbar degenerative disease with special emphasis on L5-S1 level: A technical note.
abstract: BACKGROUND
  Intraforaminal disc herniations at the L5-S1 level are extremely surgically challenging lesions. Intracanal approaches frequently require partial or total facetectomy, which may lead to instability. Solely extraforaminal approaches may offer limited visualization of the more medial superiorly exiting and inferiorly exiting nerve roots; this approach is also more complicated at L5-S1 due to the often large L5 transverse process and the iliac wing.
  
  
  METHODS
  Nine patients with intraforaminal L5-S1 disc herniations, foraminal stenosis, or synovial cysts underwent contralateral interlaminar approaches for lesion resection. Preoperative and postoperative visual analog scale scores were evaluated, and complications were reviewed.
  
  
  RESULTS
  All 9 patients demonstrated immediate postoperative clinical improvement. None of the patients exhibited complications and none developed instability or neuropathic disorders.
  
  
  CONCLUSIONS
  Although the number of cases in our sample was very small (9 in total), the contralateral interlaminar approach appeared to effectively address multiple degenerative L5-S1 foraminal pathologies. Large studies are needed to further evaluate the pros and cons of this approach.
authors.affiliation: Department of Neurosurgery, Neurosurgery Unit, IRCCS Galeazzi Hospital, Milan, Italy.
authors.forename: Edvin
authors.initials: E
authors.lastname: Zekaj
authors.affiliation: Department of Neurosurgery, Neurosurgery Unit, IRCCS Galeazzi Hospital, Milan, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Menghetti
authors.affiliation: Department of Neurosurgery, Neurosurgery Unit, IRCCS Galeazzi Hospital, Milan, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Saleh
authors.affiliation: Department of Neurosurgery, Neurosurgery Unit, IRCCS Galeazzi Hospital, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Isidori
authors.affiliation: Department of Neurosurgery, Neurosurgery Unit, IRCCS Galeazzi Hospital, Milan, Italy.
authors.forename: Alberto R
authors.initials: AR
authors.lastname: Bona
authors.affiliation: Department of Neurosurgery, Neurosurgery Unit, IRCCS Galeazzi Hospital, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Aimar
authors.affiliation: Department of Neurosurgery, Neurosurgery Unit, IRCCS Galeazzi Hospital, Milan, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Servello
keywords: Contralateral approach; intraforaminal lumbar disc herniation; mini-invasive spine surgery; spinal stability