title: Contralateral Approach for Minimally Invasive Treatment of Upper Lumbar Intervertebral Disc Herniation: Technical Note and Case Series.
abstract: BACKGROUND
  Upper lumbar disc herniations comprise only 1%-2% of all lumbar disc herniations. Patients exhibit nonspecific signs and symptoms in comparison to predictable radiculopathies, as seen in lower lumbar disc herniations. The unique anatomic characteristics of the upper lumbar spine present several challenges for safe and effective surgical treatment of disc herniations. The authors review the anatomy of the upper lumbar spine, describe a novel approach to upper lumbar disc herniations, and present 3 cases with a focus on clinical outcome and technical pearls.
  
  
  METHODS
  Conventional techniques for upper lumbar discectomy require a near complete facetectomy and pars interarticularis resection for adequate bony exposure, possibly leading to spinal destabilization. A tubular retractor system was used to approach upper lumbar disc herniation using a contralateral minimally invasive technique, while completely preserving the facet complex and pars interarticularis.
  
  
  RESULTS
  We report 3 cases of minimally invasive discectomy from a contralateral approach. The patients experienced complete resolution of presenting symptoms, and the facet complexes were preserved. All cases were free of complications.
  
  
  CONCLUSIONS
  A contralateral approach to perform a minimally invasive discectomy for paracentral and central upper LDH is a safe, efficient, and effective technique. The approach that we describe in this study preserves the facet complex and may prevent future spinal instability.
authors.affiliation: Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.
authors.forename: Ribhu T
authors.initials: RT
authors.lastname: Jha
authors.affiliation: Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.
authors.forename: Hasan R
authors.initials: HR
authors.lastname: Syed
authors.affiliation: Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Catalino
authors.affiliation: Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA. Electronic address: fasandhu@aol.com.
authors.forename: Faheem A
authors.initials: FA
authors.lastname: Sandhu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy / Q000379:methods; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D007796:Laminectomy / Q000379:methods*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Contralateral approach; Discectomy; Minimally invasive; Upper lumbar discectomy