Minimally Invasive Far-Lateral Microdiscectomy: A New Retractor for Far-Lateral Lumbar Disc Surgery

Abstract

Background To date, a number of approaches have been described for far-lateral disc surgery, including midline, paramedian, and intertransverse approaches. These approaches pose challenges for surgeons due to the difficulty in retraction caused by the anatomy of the foramen. We designed a retractor suitable for the three-dimensional anatomical structure of the foramen. In this study, we aimed to evaluate the surgical outcomes of the patients who were operated on using this retractor in our clinic. Methods The retrospective study included patients who were operated on due to far-lateral disc herniation using the retractor designed in our clinic between February 2013 and December 2018. Results The study included 11 (64.7%) women and 6 (35.3%) men, with a mean age of 56 years (range: 42-70 years). The mean operative time was 49 minutes (range: 40-70 minutes), the mean estimated blood loss was 42 mL (range: 25-60 mL), and the mean follow-up period was 22.6 months (range: 13-48 months). No complication occurred in any patient. A minimally invasive discectomy was performed via the paramedian approach in each patient. The patients were evaluated using the visual analog scale (VAS) for radicular pain, Oswestry Disability Index (ODI), 36-Item Short Form Survey (SF-36), and the modified MacNab criteria. Conclusion The retractor developed in our study provided numerous benefits during the surgical procedure as it led to minimal blood loss and reduced operative times by avoiding bone resection in extraforaminal discs and requiring minimal bone resection in foraminal discs.

Keywords: far-lateral disc herniation; microdiscectomy; minimally invasive spine surgery; new retractor.

Figure 1. Retractor (drawing by the patent team).

Figure 2. (A) Draft drawing of the retractor. (B) Lateral blade. (C) Medial blade.

Figure 3. The medial (short-narrow) blade of the retractor consisted of two parts: the proximal part of the medial blade was inserted between the facet joints and the distal part was placed above the pars interarticularis. The lateral (long-wide) blade of the retractor was used to move the lateral muscles away from the surgical field.