Midline mini-incision approach with superolateral facet joint quadrantectomy for extraforaminal disc herniations: A modified technique and outcomes
Abstract
Objectives: Extraforaminal disc herniations constitute 3-12% of all lumbar disc herniations. In the literature, many surgical procedures have been described for extraforaminal disc herniations, including roughly medial and lateral approaches. In our study, we discussed the clinical results of cases in which we applied the superolateral quadrantectomy (resection of the superolateral quarter of the facet joint) technique described in the literature but modified by us, and we made conclusions about the technique. Patient outcomes were evaluated using the Macnab criteria: excellent, good, fair, and poor.
Methods: Between 2019 and 2023, 72 patients who were operated on with the diagnosis of single-level extraforaminal lumbar disc herniation and underwent superolateral facet joint quadrantectomy via mini incision-midline approach in our clinic were retrospectively analyzed.
Results: Preoperative Visual Analog Scale scores were 4-10 (mean: 8.5±2.17). Postoperative scores were 0-1 (mean: 0.3±0.1). According to the Macnab classification, 37 (51.39%) of the patients were evaluated as excellent, and 27 (37.50%) in the third postoperative month. Postoperative follow-up dynamic radiographs showed no instability in patients at the end of the 1st year. There were no perioperative complications in any of the cases.
Conclusions: The modified technique that we have described offers the potential advantages of preserving the facet joint capsule and reducing the size of the incision.
Keywords
Extraforaminal disc herniation superolateral quadrantectomy combined approach mini-incision
Ethical Statement
This study was approved by the University of Health Sciences, Bursa Yüksek Ihtisas Training and Research Hospital, Medical Sciences Ethics Committee (Decision no. 2024-TBEK 2024/04-09, date: 17.04.2024).
References
- 1. Akinduro OO, Kerezoudis P, Alvi MA, et al. Open Versus Minimally Invasive Surgery for Extraforaminal Lumbar Disk Herniation: A Systematic Review and Meta-Analysis. World Neurosurg. 2017;108:924-938.e3. doi: 10.1016/j.wneu.2017.08.025.
- 2. Marquardt G, Bruder M, Theuss S, Setzer M, Seifert V. Ultra-long-term outcome of surgically treated far-lateral, extraforaminal lumbar disc herniations: a single-center series. Eur Spine J. 2012;21(4):660-665. doi: 10.1007/s00586-011-2123-9.
- 3. Jang JS, An SH, Lee SH. Transforaminal percutaneous endoscopic discectomy in the treatment of foraminal and extraforaminal lumbar disc herniations. J Spinal Disord Tech. 2006 Jul;19(5):338-343. doi: 10.1097/01.bsd.0000204500.14719.2e.
- 4. Gioia G, Mandelli D, Capaccioni B, Randelli F, Tessari L. Surgical treatment of far lateral lumbar disc herniation. Identification of compressed root and discectomy by lateral approach. Spine (Phila Pa 1976). 1999;24(18):1952-1957. doi: 10.1097/00007632-199909150-00015.
- 5. Lee DY, Lee SH. Microdecompression for extraforaminal L5-s1 disc herniation; the significance of concomitant foraminal disc herniation for postoperative leg pain. J Korean Neurosurg Soc. 2008;44(1):19-25. doi: 10.3340/jkns.2008.44.1.19.
- 6. Dereymaeker L, Brouns R, Herregodts P, et al. Disc Fragment Herniectomy Through a Facet Joint Quadrantectomy for Extraforaminal Lumbar Herniation: Technique and Results. World Neurosurg. 2016;85:228-235. doi: 10.1016/j.wneu.2015.09.002.
- 7. Lofrese G, Mongardi L, Cultrera F, Trapella G, De Bonis P. Surgical treatment of intraforaminal/extraforaminal lumbar disc herniations: Many approaches for few surgical routes. Acta Neurochir (Wien). 2017;159(7):1273-1281. doi: 10.1007/s00701-017-3198-9.
- 8. Epstein NE. Different surgical approaches to far lateral lumbar disc herniations. J Spinal Disord. 1995;8(5):383-394.
- 9. Ryang YM, Rohde I, Ince A, Oertel MF, Gilsbach JM, Rohde V. Lateral transmuscular or combined interlaminar/paraisthmic approach to lateral lumbar disc herniation? A comparative clinical series of 48 patients. J Neurol Neurosurg Psychiatry. 2005;76(7):971-976. doi: 10.1136/jnnp.2004.051102.
- 10. Eicker SO, Rhee S, Steiger HJ, Herdmann J, Floeth FW. Transtubular microsurgical approach to treating extraforaminal lumbar disc herniations. Neurosurg Focus. 2013;35(2):E1. doi: 10.3171/2013.4.FOCUS13126.
- 11. Epstein NE. Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results. J Neurosurg. 1995;83(4):648-656. doi: 10.3171/jns.1995.83.4.0648.
Abstract
References
- 1. Akinduro OO, Kerezoudis P, Alvi MA, et al. Open Versus Minimally Invasive Surgery for Extraforaminal Lumbar Disk Herniation: A Systematic Review and Meta-Analysis. World Neurosurg. 2017;108:924-938.e3. doi: 10.1016/j.wneu.2017.08.025.
- 2. Marquardt G, Bruder M, Theuss S, Setzer M, Seifert V. Ultra-long-term outcome of surgically treated far-lateral, extraforaminal lumbar disc herniations: a single-center series. Eur Spine J. 2012;21(4):660-665. doi: 10.1007/s00586-011-2123-9.
- 3. Jang JS, An SH, Lee SH. Transforaminal percutaneous endoscopic discectomy in the treatment of foraminal and extraforaminal lumbar disc herniations. J Spinal Disord Tech. 2006 Jul;19(5):338-343. doi: 10.1097/01.bsd.0000204500.14719.2e.
- 4. Gioia G, Mandelli D, Capaccioni B, Randelli F, Tessari L. Surgical treatment of far lateral lumbar disc herniation. Identification of compressed root and discectomy by lateral approach. Spine (Phila Pa 1976). 1999;24(18):1952-1957. doi: 10.1097/00007632-199909150-00015.
- 5. Lee DY, Lee SH. Microdecompression for extraforaminal L5-s1 disc herniation; the significance of concomitant foraminal disc herniation for postoperative leg pain. J Korean Neurosurg Soc. 2008;44(1):19-25. doi: 10.3340/jkns.2008.44.1.19.
- 6. Dereymaeker L, Brouns R, Herregodts P, et al. Disc Fragment Herniectomy Through a Facet Joint Quadrantectomy for Extraforaminal Lumbar Herniation: Technique and Results. World Neurosurg. 2016;85:228-235. doi: 10.1016/j.wneu.2015.09.002.
- 7. Lofrese G, Mongardi L, Cultrera F, Trapella G, De Bonis P. Surgical treatment of intraforaminal/extraforaminal lumbar disc herniations: Many approaches for few surgical routes. Acta Neurochir (Wien). 2017;159(7):1273-1281. doi: 10.1007/s00701-017-3198-9.
- 8. Epstein NE. Different surgical approaches to far lateral lumbar disc herniations. J Spinal Disord. 1995;8(5):383-394.
- 9. Ryang YM, Rohde I, Ince A, Oertel MF, Gilsbach JM, Rohde V. Lateral transmuscular or combined interlaminar/paraisthmic approach to lateral lumbar disc herniation? A comparative clinical series of 48 patients. J Neurol Neurosurg Psychiatry. 2005;76(7):971-976. doi: 10.1136/jnnp.2004.051102.
- 10. Eicker SO, Rhee S, Steiger HJ, Herdmann J, Floeth FW. Transtubular microsurgical approach to treating extraforaminal lumbar disc herniations. Neurosurg Focus. 2013;35(2):E1. doi: 10.3171/2013.4.FOCUS13126.
- 11. Epstein NE. Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results. J Neurosurg. 1995;83(4):648-656. doi: 10.3171/jns.1995.83.4.0648.
Details
| Primary Language | English |
|---|---|
| Subjects | Brain and Nerve Surgery (Neurosurgery) |
| Journal Section | Original Articles |
| Authors | |
| Early Pub Date | June 10, 2025 |
| Publication Date | July 4, 2025 |
| Submission Date | February 2, 2025 |
| Acceptance Date | April 3, 2025 |
| Published in Issue | Year 2025 Volume: 11 Issue: 4 |
