SURGICAL VIDEO Minimally Invasive Extraforaminal Discectomy Joshua W. Lucas, MD,JohnC.Liu,MD Department of Neurosurgery, University of Southern California, Los Angeles, California This surgical video demonstrates the standard technique of a minimally invasive (MIS) approach to an extraforaminal disk herniation. Typically, open approaches for these lesions often require large exposures with violation of the facet joint and subpe- Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/ riosteal muscle dissection, potentially leading to future iatrogenic opx138 instability. The MIS muscle-splitting approach obviates the need for facet joint violation and provides direct access to the herniated disk, allowing for its removal using standard microdiscectomy COMMENT techniques. Standard MIS techniques involving localization with fluoroscopy and sequential dilation and tube placement are he authors provide a video description of a minimally invasive far used to dock the MIS tube directly on the transverse process of T lateral microdiscectomy. Far-lateral disk herniations comprise 10– the involved level. The fascia and muscle in the intertransverse 12% of lumbar disk herniations. Patients often present with leg pain after process space are removed to expose the exiting nerve root and their initial back pain subsides. The pain can oftentimes be severe due disk. A standard microdiscectomy is then performed to alleviate to the compression of the dorsal root ganglion. There has been a shift compression on the nerve root. This technique allows for a very towards adopting minimally invasive approaches for their management due to the advantages of minimal blood loss and soft tissue disruption. localized approach to the pathology with minimal disruption to The authors provide an excellent video illustration of a patient who the normal anatomy of the spine. Informed consent was obtained suffered from a far-lateral disk herniation that was mainly extraforaminal from the patient for the surgery and the publication of this in location precluding the need for any bony resection. Far-lateral disks video. can also be foraminal in location and in these situations the lateral aspect of the pars interarticularis and superior part of the superior facet of the caudal level may need to be resected to enhance the exposure. Disclosure The authors have no personal, financial, or institutional interest in any of the Nader S. Dahdaleh drugs, materials, or devices described in this article. Chicago, Illinois 318 | VOLUME 14 | NUMBER 3 | MARCH 2018 www.operativeneurosurgery-online.com Downloaded from https://academic.oup.com/ons/article-abstract/14/3/318/4004611 by Ed 'DeepDyve' Gillespie user on 16 March 2018
Operative Neurosurgery – Oxford University Press
Published: Mar 1, 2018
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