title: Extraforaminal Disk Herniation Treatment with Surgical Exploration by Unilateral Intertransversarii Microsurgical Approach.
abstract: In this study we evaluated the role of a unilateral intertransversarii microsurgical approach for the treatment of extraforaminal lumbar disk herniations (ELDHs), with short-, medium-, and long-term follow-up.
  
  
  
  We retrospectively evaluated 96 patients who had undergone surgery for ELDH between 2001 and 2012 at our Institution. All the patients had been examined before the intervention, immediately after, and at 6 weeks, 6 months, and 18 months after the intervention. All the patients underwent surgical exploration with a unilateral intertransversarii microsurgical approach. After a midline incision was made, the paraspinal muscles were retracted laterally up to the transverse process, in order to visualize the intertransversarii ligament. Removal of this ligament allows microsurgical exposure of the extraforaminal pathology. If necessary, interlaminar microsurgical exploration is performed in the same session.
  
  
  
  At 6-week postoperative follow-up we noted a significant decrease of pain both in patients who suffered from leg pain and in patients who reported back pain. Also, sensory and motor deficits had improved considerably. At 6-month postoperative follow-up we observed a further improvement in the clinical conditions of almost all patients. At the 18-month postoperative follow-up we observed a very low incidence of relapse of neurological symptoms.
  
  
  
  Our technique can be reasonably proposed because of its low morbidity, fast recovery, and short hospital stay.
authors.affiliation: Section of Neurosurgery, Department of Clinical Neurosciences, N.C.L. Neurological Center of Latium, Via Patrica 15, Rome, 00178, Italy. segreteria1@nclroma.it.|Department of Biomedicine, University of Rome "Tor Vergata", Rome, Italy. segreteria1@nclroma.it.
authors.forename: Aldo
authors.initials: A
authors.lastname: Spallone
authors.affiliation: Insitute of Neurosurgery, Medical School, Catholic University of Rome, Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Visocchi
authors.affiliation: Section of Neurosurgery, Department of Clinical Neurosciences, N.C.L. Neurological Center of Latium, Via Patrica 15, Rome, 00178, Italy.|Section of Neurophysiology, Department of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Nardella
authors.affiliation: Section of Neurosurgery, Department of Clinical Neurosciences, N.C.L. Neurological Center of Latium, Via Patrica 15, Rome, 00178, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Lavorato
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000601:surgery*; D007866:Leg; D008159:Lumbar Vertebrae; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010147:Pain Measurement; D064170:Paraspinal Muscles; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Disk herniation; Extraforaminal; Microsurgery; Neurosurgical procedure; Paraspinal muscle