JNS Paper Extraforaminal Disc

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Percutaneous intertransverse extraforaminal discectomy for extraforaminal disc herniations: Surgical Technique and clinical results.

Journal: Manuscript ID: Manuscript Category: Which Journal: Date Submitted by the Author: Complete List of Authors:

Keywords:

Journal of Neurosurgery draft Technical Note Spine n/a Choi, Gun; Wooridul Spine Hospital, Neurosurgery Lee, Sang-Ho; ; Wooridul Spine Hospital, Neurosurgery Pai-Raiturker, Pradyumna; Wooridul Spine Hospital, Orthopedic Chae, Yu-Sik; Wooridul Spine Hospital, Neurosurgery Extraforaminal disc herniation , percutaneous endoscopic discectomy, intertransverse extraforaminal approach, minimally invasive

ScholarOne, 375 Greenbrier Drive, Charlottesville, VA, 22901 1.434.817.2040 ext. 167

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ዊዊዊዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊ ዊዊ ዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊ ዊዊዊዊዊዊዊዊዊ ዊዊ ዊዊዊዊዊዊዊዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊ ዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊ ዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

ዊ ዊ ዊ ዊ ዊዊ ዊዊዊዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊ ዊዊዊ ዊዊዊ ዊዊዊዊዊዊዊዊዊ ዊዊዊዊ ዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊ ዊዊዊዊ

ዊዊዊዊዊ ዊ ዊዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊ ዊዊዊዊዊ ዊዊዊዊዊዊዊዊ ዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊ ዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊ ዊዊዊዊዊ ዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

ዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊ ዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊ ዊዊ ዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

ዊ ዊ ዊ ዊዊዊዊ ዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊ ዊዊዊዊ ዊዊዊ ዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊ ዊዊዊዊዊ ዊዊ ዊዊዊዊዊዊዊ ዊዊዊ ዊዊዊ ዊዊዊዊዊዊዊዊ ዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

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ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

ዊ ዊ ዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊ ዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ ዊዊዊዊዊዊዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

ዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊዊ

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Materials and Methods

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ScholarOne, 375 Greenbrier Drive, Charlottesville, VA, 22901 1.434.817.2040 ext. 167

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ScholarOne, 375 Greenbrier Drive, Charlottesville, VA, 22901 1.434.817.2040 ext. 167

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ScholarOne, 375 Greenbrier Drive, Charlottesville, VA, 22901 1.434.817.2040 ext. 167

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ScholarOne, 375 Greenbrier Drive, Charlottesville, VA, 22901 1.434.817.2040 ext. 167

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ScholarOne, 375 Greenbrier Drive, Charlottesville, VA, 22901 1.434.817.2040 ext. 167

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ScholarOne, 375 Greenbrier Drive, Charlottesville, VA, 22901 1.434.817.2040 ext. 167

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CONCLUSION Percutaneous intertransverse extraforaminal endoscopic discectomy is a safe and effective minimally invasive function preserving technique to treat extraforaminal disc herniations in properly selected cases. It differs from the routine transforaminal endoscopic technique. It is a direct targeted approach to the extraforaminal disc herniations in which the exiting root can be selectively decompressed with added advantages of being cost-effective, cosmetic and especially well tolerated by the elderly patients with co morbid conditions as it is done under local anesthesia.

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Reference List 1. Abdullah, A. F. Lateral disc herniations. J Neurosurg 76(2), 342-343. 92.

2. Abdullah, A. F., Ditto, E. W., Byrd, E. B., and Williams, R. Extreme-lateral lumbar disc herniations. Clinical syndrome and special problems of diagnosis. J Neurosurg 41(2), 229-234. 74.

3. Bae HG, Choi SK, Joo KS, et al: Morphometric aspects of extraforaminal lumbar nerve roots. Neurosurgery 44:841-6, 1999

4. Darden, B. V., Wade, J. F., Alexander, R., Wood, K. E., Rhyne, A. L., and Hicks, J. R. Far lateral disc herniations treated by microscopic fragment excision. Techniques and results. Spine 20(13), 1500-1505. 95.

5. Ditsworth DA: Endoscopic transforaminal lumbar discectomy and reconfiguration: a postero-lateral approach into the spinal canal. Surgical Neurology 49:588-97; 1998

6. Ducker TB: Extreme lateral lumbar disc herniation. J Spinal Disord Tech 2:131-2; discussion 13341, 1989

7. Ebraheim NA, Xu R, Huntoon M, et al: Location of the extraforaminal lumbar nerve roots. An anatomic study. Clin Orthop230-5, 1997

8. Epimenio, R. O., Giancarlo, D., Giuseppe, T., Raffaelino, R., and Luigi, F. Extraforaminal lumbar herniation: "far lateral" microinvasive approach retrospective study. J Spinal Disord Tech 16(6), 534-538. 2003.

9. Epstein, N. E. Different surgical approaches to far lateral lumbar disc herniations. J Spinal Disord Tech 8(5), 383-394. 95.

10. Fankhauser H, de Tribolet N: Extreme lateral lumbar disc herniation. Br J Neurosurg 1:111-29, 1987

11. Gioia G, Mandelli D, Capaccioni B, et al: Surgical treatment of far lateral lumbar disc herniation. Identification of compressed root and discectomy by lateral approach. Spine 24:1952-7, 1999

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12. Greiner-Perth R, Bohm H, Allam Y: A new technique for the treatment of lumbar far lateral disc herniation: technical note and preliminary results. Eur Spine J 12:320-4, 2003

13. Hodges SD, Humphreys SC, Eck JC, et al: The surgical treatment of far lateral L3-L4 and L4-L5 disc herniations. A modified technique and outcomes analysis of 25 patients. Spine 24:1243-6, 1999

14. Hood RS: Far lateral lumbar disc herniations. Neurosurg Clin N Am 4:117-24, 1993

15. Jackson RP, Glah JJ: Foraminal and extraforaminal lumbar disc herniation: diagnosis and treatment. Spine 12:577-85, 1987

16. Kambin P: Percutaneous endoscopic discectomy. Journal of Neurosurgery 79:968-9; author reply 969-70, 1993

17. Kambin, P. Arthroscopic microdiscectomy. Spine J 3(3 Suppl), 60S-64S. 2003.

18. Kambin P, Brager MD: Percutaneous posterolateral discectomy. Anatomy and mechanism. Clinical Orthopaedics and Related Research145-54, 1987

19. Kambin P, O_Brien E, Zhou L, et al: Arthroscopic microdiscectomy and selective fragmentectomy. Clinical Orthopaedics and Related Research150-67, 1998

20. Knop-Jergas BM, Zucherman JF, Hsu KY, et al: Anatomic position of a herniated nucleus pulposus predicts the outcome of lumbar discectomy. J Spinal Disord Tech 9:246-50, 1996

21. Kunogi J, Hasue M: Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine 16:1312-20, 1991

22. Kurobane Y, Takahashi T, Tajima T, et al: Extraforaminal disc herniation. Spine 11:260-8, 1986

23. Lew SM, Mehalic TF, Fagone KL: Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations. J Neurosurg 94:216-20, 2001

24. Macnab, I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60

eight patients. J Bone Joint Surg Am 53(5), 891-903. 71.

25. Maroon JC, Kopitnik TA, Schulhof LA, et al: Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine. J Neurosurg 72:378-82, 1990

26. Mathews HH: Transforaminal endoscopic microdiscectomy. Neurosurgery Clinics of North America 7:59-63, 1996

27. Melvill RL, Baxter BL: The intertransverse approach to extraforaminal disc protrusion in the lumbar spine. Spine 19:2707-14, 1994

28. Mirkovic SR, Schwartz DG, Glazier KD: Anatomic considerations in lumbar posterolateral percutaneous procedures. Spine 20:1965-71, 1995

29. Muller, A. and Reulen, H. J. A paramedian tangential approach to lumbosacral extraforaminal disc herniations. Neurosurgery 43(4), 854, 61; discussion 861-2. 98.

30. O'Hara LJ, Marshall RW: Far lateral lumbar disc herniation. The key to the intertransverse approach. J Bone Joint Surg Br 79:943-7, 1997

31. Patsiaouras T, Bulstrode C, Cook P, et al: Percutaneous nucleotomy. An anatomic study of the risks of root injury. Spine 16:39-42, 1991

32. Perez_Cruet MJ, Foley KT, Isaacs RE, et al: Microendoscopic lumbar discectomy: technical note. Neurosurgery 51:129-36, 2002

33. Porchet, F., Chollet_Bornand, A., and de_Tribolet, N. Long-term follow up of patients surgically treated by the far-lateral approach for foraminal and extraforaminal lumbar disc herniations. J Neurosurg 90(1 Suppl), 59-66. 99.

34. Postacchini F. GS: Results Of Surgery, Lumbar Disc Herniation. Wien: Springer Verlag, 1999, pp 507-520

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35. Reulen H-JMD, Muller AMD, Ebeling UMD: Misrosurgical anatomy of the lateral approach to extraforaminal lumbar disc herniations. Neurosurgery 39:345-351, 1996

36. Siebner HR, Faulhauer K: Frequency and specific surgical management of far lateral lumbar disc herniations. Acta Neurochir (Wien) 105:124-31, 1990

37. Strum PF, Armstrong GW, O'Neil DJ, et al: Far lateral lumbar disc herniation treated with an anterolateral retroperitoneal approach. Report of two cases. Spine 17:363-5, 1992

38. Tessitore E, de Tribolet N: Far-lateral lumbar disc herniation: the microsurgical transmuscular approach. Neurosurgery 54:939-42, 2004

39. Viswanathan, R., Swamy, N. K., Tobler, W. D., Greiner, A. L., Keller, J. T., and Dunsker, S. B. Extraforaminal lumbar disc herniations: microsurgical anatomy and surgical approach. J Neurosurg 96(2 Suppl), 206-211. 2002.

40. Wiltse, L. L. The paraspinal sacrospinalis-splitting approach to the lumbar spine. Clin Orthop 91, 48-57. 73.

41. Wiltse, L. L., Bateman, J. G., Hutchinson, R. H., and Nelson, W. E. The paraspinal sacrospinalissplitting approach to the lumbar spine. J Bone Joint Surg Am 50(5), 919-926. 68.

42. Wiltse, L. L. and Spencer, C. W. New uses and refinements of the paraspinal approach to the lumbar spine. Spine 13(6), 696-706. 88.

43. Gu Y, Ebraheim NA, Yeasting R. Anatomical Considerations of the Posterolateral Lumbar Disk Region. Orthopedics 24(1):56-58, 2001

44. Yeung AT, Tsou PM: Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine 27:722-31, 2002

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Acknowledgement: We wish to acknowledge Sung-Hee Myung, Jihee Hwang and Il Lee for their help in the preparation of this manuscript.

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Figure Legends: Figure No. 1 Intraoperative image intensifier images [AP (A) and Lateral (B)] showing the steep angulation and position of the working cannula.

Figure No. 2 Intraoperative Endoscope view showing the blue stained extraforaminal herniated disc herniation being probed and the overlying exiting nerve root covered by adipose tissue.

Figure No.3 Preoperative MRI (A) scan Image showing the extraforaminal disc herniation (white arrow) and postoperative MRI (B) showing complete removal of the extraforaminal herniated disc (black arrow) after percutaneous intertransverse extraforaminal endoscopic discectomy

Figure No. 4 Graph showing the frequency of levels affected.

Figure No. 5 Graphs showing improvement in Visual Analogue scale [VAS] (A) for leg pain and Oswestry Disability Index [ODI] (B) after Percutaneous intertransverse extraforaminal endoscopic discectomy.

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Figure No. 6 Targetting at the superior endplate of lower vertebra and at the lateral pedicle wall gives adequate space for cannula placement.

Figure No 7 In comparison to the transforaminal approach, the angle is steep and skin entry point is closer to midline [A and B] for percutaneous extraforaminal approach for extraforaminal disc herniations.

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FIGURE NO 7

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