Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results

摘要: This study was undertaken to determine and compare indications relative benefits of various surgical approaches in 170 patients (average age 55 years) with far-lateral herniated lumbar discs, identified by magnetic resonance (MR) imaging computerized tomography (CT) operated on between 1984 1994. Essentially three procedures were performed: complete facetectomy 73 patients, laminotomy medial 39 intertransverse discectomy (also known as ITT) 58 patients. Follow-up periods averaged 5 years (range 0.5-10 years). Outcomes scored excellent (no deficit), good (mild radiculopathy), fair (moderate poor (unchanged or worse). Overall, results achieved 51 respectively, 26 20, respectively. There little difference among the encountered for major groups: 79% (ITT) group had good-to-excellent outcomes, compared 70% group, 68% who underwent at minimum laminotomy, additional hemilaminectomy laminectomy facetectomy. Results same 121 followed more than 2 49 studied under years. In management total provides best exposure, but increases risk instability. Laminotomy uncover lateral subarticular recess preserve stability, visualization compartment is often inadequate. The approach offers extensive not intraforaminal while also preserving stability. Full facetectomy, yielded nearly comparable outcomes disc surgery. Only full exposes entire course nerve root both medially laterally, whereas procedure direct exposure fat-lateral alone. It important select correct combination address attendant complicating factors such spinal stenosis, spondyloarthrosis, degenerative spondylolisthesis CT MR studies.