Contralateral approach for far lateral lumbar disc herniations: a modified technique and outcome analysis of nine patients

Abstract

Study design: A retrospective analysis of 9 patients who underwent a modified surgical procedure for the treatment of far lateral lumbar disc herniations.

Objectives: To illustrate a modified technique for approaching the neural foramen from the contralateral side, minimizing muscle retraction and bone/ligament resection, and to analyze clinical results.

Summary of background data: The most commonly used surgical techniques for the removal of far lateral lumbar disc herniations are ipsilateral approaches, that require partial or complete facet resection and/or intertransverse ligament resection, which may result in vertebral instability and/or chronic back pain.

Methods: Nine patients with intraforaminal or intra/extraforaminal lumbar disc herniation underwent surgery using a modified contralateral approach. There was unilateral muscle retraction and no medial facetectomy nor intertransverse/interspinous ligament resection. Preoperative and postoperative Oswestry functional status evaluation and complications were reviewed and Macnab's postoperative categories were assigned to evaluate the efficacy and safety of the surgery.

Results: No serious complications were noted. The mean preoperative and postoperative Oswestry scores were 44 and 14 respectively (P < 0.01). Overall excellent-to-good results were 100%.

Conclusion: This modified contralateral approach offered a wide exposure of intervertebral foramen region and allowed to remove the herniated disc material with minimal resection of osseous and ligamentous structures. Successful results were achieved in all patients treated by this technique.