Unilateral Paramedian Transpedicular Approach for Repair of Anterior Transdural Spinal Cord Herniation: Report of a Case and Literature Review

Idiopathic spinal cord herniation is a rare but potentially treatable cause of thoracic myelopathy. The rarity and variable clinical presentation often results in missed diagnosis and delay in treatment. Posterior midline approach with laminectomy has been the most common approach performed for spinal cord herniation in cases described in the literature. A posterior approach is limited by the danger of retracting the spinal cord and difficulty visualizing the dural defect. Considering the anterior location of the dural defect, a posterolateral allows for a more ventral view without spinal cord manipulation. We report a rare case of idiopathic spinal cord herniation which was managed by unilateral paramedian transpedicular approach with an excellent clinical outcome.

Minimally invasive lumbar microendoscopic discectomy in the pregnant patient: report of two cases

While back pain is a common occurrence during pregnancy, having been reported in up to 50% of all gestations, rarely are hemiated intervertebral discs found. Hemiated lumbar intervertebral discs have a reported incidence of 1 in 10,000 pregnant patients, and therefore surgical intervention is rarely necessary during gestation. Minimally invasive lumbar microendoscopic discectomy during pregnancy has not been reported in the literature. Here, we describe two cases where this technique was used in pregnant patients. Two cases are presented. A 35-year-old G4P3 female presented with left leg radicular symptoms. An MRI revealed a large left L4 - 5 disc hemiation. After failing conservative therapy, she underwent a left minimally invasive L4 - 5 microendoscopic discectomy at 15 weeks gestation. A 36-year-old G2P1 female developed left leg radicular symptoms at 19 weeks gestation. An EMG was performed which showed a left S1 radiculopathy, and an MRI showed a large left L5 - S1 disc hemiation. She failed conservative therapy and underwent a left minimally invasive L5 - S1 microendoscopic discectomy in the lateral decubitus position at 27 weeks gestation. Both patients had full recovery of their radicular symptoms after surgery. Hospital stay was less than 24 hours, and both patients delivered without complication at full term. They suffered no deleterious effects from anaesthetic administration. Minimally invasive lumbar microendoscopic discectomy is a viable option for the surgical treatment of symptomatic lumbar disc hemiations in symptomatic pregnant patients. While the surgical technique may need to be modified due to the gravid abdomen by using the lateral decubitus position and minimizing radiographic exposure, this procedure provides the added benefit of shorter operative time, decreased narcotic requirement, and shorter length of hospital stay