title: Topographical principles and peculiarities of operative access in lumbar disc extrusion.
abstract: For the operative procedure in lumbar disc extrusion it is important to expose the prolapsed disc and sequestrum without disintegration of the musculature and branches of r. dorsalis nervi spinalis or provoking lesions in the spinal canal. A classification helps to determine exact description of localization of disc material in craniocaudal and mediolateral directions. It can be correlated with the interlaminar window as a structure seen in the operative procedure. A speculum helps to limit the exposure for an interlaminar as well as a lateral access, thus reaching the structures concerned in the spinal canal with minimal irritation of the surrounding tissues. For interlaminar access partial excision of the lig. flavum is sufficient. The extrusions in the foraminal region that can be exposed laterally from a medial skin incision, as well as from a paramedial are between m. multifidus and m. longissimus. In revision surgery, the upper laminar corner is advantageous for entering the spinal canal.
authors.affiliation: Orthopädische Universitätsklinik der Ruhr-Universität Bochum, St. Josef-Hospital, Bochum, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Grifka
authors.affiliation: Institut für Spezielle Zoologie und Evolutionsbiologie, Friedrich-Schiller-Universität Jena, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Witte
authors.affiliation: Abteilung für Neuroanatomie und Molekulare Hirnfoschung, Medizinische Fakultät der Ruhr-Universität Bochum, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Faustmann
authors.affiliation: Klinik Fleetinsel Hamburg, Abteilung für Orthopädie II, Hamburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Heers
authors.affiliation: Orthopädische Universitätsklinik der Ruhr-Universität Bochum, St. Josef-Hospital, Bochum, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Broll-Zeitvogel
keywords: Key words Lumbar disc extrusion • Topographical principles • Discectomy