Surgical treatment of intraforaminal/extraforaminal lumbar disc herniations: Many approaches for few surgical routes View Full Text


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Article Info

DATE

2017-05-22

AUTHORS

Giorgio Lofrese, Lorenzo Mongardi, Francesco Cultrera, Giorgio Trapella, Pasquale De Bonis

ABSTRACT

BackgroundSeveral disc disease nomenclatures and approaches for LDH exist. The traditional midline bone-destructive procedures together with approaches requiring extreme muscular retraction are being replaced by muscle sparing, targeted, stability-preserving surgical routes. The increasing speculation on LDHs and the innovative corridors described to treat them have lead to an extensive production of papers frequently treating the same topic but adopting different terminologies and reporting contradictory results.MethodsThe review of such literature somehow confounding gave us the chance to regroup by surgical corridors the vast amount of approaches for LDH differently renamed over time. Likewise, LDHs were simplified in intra-foraminal (ILDH), extra-foraminal (ELDH), and intra−/extra-foraminal (IELDH) in relation to precise anatomical boundaries and extent of bulging disc.ResultsThrough the analysis of the papers, it was possible to identify ideal surgical corridors for ILDHs, ELDHs, and IELDHs, distinguishing for each approach the exposure provided and the technical advantages/disadvantages in terms of muscle trauma, biomechanical stability, and nerve root preservation. A significant disproportion was noted between studies discussing traditional midline approaches or variants of the posterolateral route and those investigating pros and cons of simple or combined alternative corridors. Although rarely discussed, these latter represent valuable strategies particularly for the challenging IELDHs, thanks to the optimal compromise between herniation exposure and bone-muscle preservation.ConclusionsThe integration of adequate mastery of traditional approaches together with a greater confidence through unfamiliar surgical corridors can improve the development of combined mini-invasive procedures, which seem promising for future targeted LDH excisions. More... »

PAGES

1273-1281

References to SciGraph publications

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  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s00701-017-3198-9

    DOI

    http://dx.doi.org/10.1007/s00701-017-3198-9

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1085458720

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/28534073


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