Microsurgical muscle-splitting approach for extracanalicular lumbar disc herniation : An analysis of 28 consecutive cases


Published online: Feb 27 2009

Theodossios Birbilis, Dimitrios Koulalis, Georgios Matis, Efthymia Theodoropoulou, Kleo Papaparaskeva

From the Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece

Abstract

Extracanalicular lumbar disc herniation (ELDH) is a specific clinical entity with compression of the nerve root in its extraforaminal course. The classical midline interlaminar approach is often difficult because the facet joint obviates a direct view of the nerve, and a partial facetectomy is required. Consequently, the risk of instability or continued postoperative back pain is increased. The authors performed a micro-surgical muscle-splitting approach in an attempt to obtain a direct view of the disc rupture without sacrificing the facet joint. Twenty-eight consecutive patients were operated upon with this surgical procedure. A retrospective study showed that 10 patients (35.7%) had an excellent, 13 (46.4%) a good, 4 (14.3%) a fair and one (3.6%) a poor result, according to the Macnab criteria. No serious postoperative complications were noted. This procedure is safe, effective and less invasive.