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. 2016 Sep 21:7:88.
doi: 10.4103/2152-7806.191024. eCollection 2016.

Contralateral interlaminar approach for intraforaminal lumbar degenerative disease with special emphasis on L5-S1 level: A technical note

Edvin Zekaj  1 , Claudia Menghetti  1 , Christian Saleh  1 , Alessandra Isidori  1 , Alberto R Bona  1 , Enrico Aimar  1 , Domenico Servello  1
Affiliations

Contralateral interlaminar approach for intraforaminal lumbar degenerative disease with special emphasis on L5-S1 level: A technical note

Edvin Zekaj et al. Surg Neurol Int. .

Abstract

Background: Intraforaminal disc herniations at the L5-S1 level are extremely surgically challenging lesions. Intracanal approaches frequently require partial or total facetectomy, which may lead to instability. Solely extraforaminal approaches may offer limited visualization of the more medial superiorly exiting and inferiorly exiting nerve roots; this approach is also more complicated at L5-S1 due to the often large L5 transverse process and the iliac wing.

Methods: Nine patients with intraforaminal L5-S1 disc herniations, foraminal stenosis, or synovial cysts underwent contralateral interlaminar approaches for lesion resection. Preoperative and postoperative visual analog scale scores were evaluated, and complications were reviewed.

Results: All 9 patients demonstrated immediate postoperative clinical improvement. None of the patients exhibited complications and none developed instability or neuropathic disorders.

Conclusions: Although the number of cases in our sample was very small (9 in total), the contralateral interlaminar approach appeared to effectively address multiple degenerative L5-S1 foraminal pathologies. Large studies are needed to further evaluate the pros and cons of this approach.

Keywords: Contralateral approach; intraforaminal lumbar disc herniation; mini-invasive spine surgery; spinal stability.

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Figures

Figure 1
Figure 1
(a) Axial lumbosacral computed tomography (CT) scan showing left intraforaminal synovial cyst. (b) postsurgical CT scan showing cyst removal with preservation of facet joint
Figure 2
Figure 2
(a) Axial lumbosacral computed tomography (CT) scan showing foraminal stenosis at L5-S1 on the left. (c) Sagittal reconstruction of CT scan showing osteophytes in the lower part of the foramen. (b, d) Postsurgical axial and sagittal CT scan showing removal of the osteophytes and decompression of foramen with preservation of facet joints
Figure 3
Figure 3
(a) An axial T2 lumbosacral magnetic resonance imaging (MRI) showing a pure left intraforaminal lumbar disc herniation at L5-S1. (b) Sagittal T2 MRI images showing foraminal stenosis due to lumbar disc herniation
See this image and copyright information in PMC

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