Transfacet Pedicle Sparing Approach in High Lumbar Disc Herniation

OBJECTIVE: The authors evaluate results of transfacet pedicle sparing approach for high lumbar disc herniation to avoid injury of nerve roots and the cauda equina. METHODS: Seven patients treated by transfacet pedicle sparing approach for high lumbar disc herniation were reviewed. Some thoracolumbar kyphotic patients on whom posterior procedures underwent additional posterior lumbar interbody fusion and posterolateral fusion using the mesh cage and spinal instrumentation. RESULTS: Clinical symptoms improved in all seven patients. Rigid spinal stability and correction of thoracolumbar kyphosis could be performed by the spinal instrumentation methods. CONCLUSION: The advantages of the transfacet pedicle sparing approach are less invasive, easy decompression the nerve root directly and avoidance of the risk of injury to the cauda equina while the dura is being retracted. Additionally, thoracolumbar kyphosis could be corrected. Transfacet pedicle sparing approach is an useful procedure in the surgical treatment of high lumbar disc herniation.

High Lumbar Disc Herniation Treated with A Modified Posterolateral Approach: Case Report

Generally, the posterolateral approach had been recommended in case of extraforaminal disc herniation or lateral stenosis but it has been speculated that this procedure may be feasible to posterolateral disc herniation at the high lumbar levels of the L1-L2 interspace. Topographically, a posterolateral approach should be able to access anteromedial side of the spinal canal without the risk of the bony instability and damage to the neural structures. During the past one year period, three patients with high lumbar discs at the L1-L2 level were treated by the modified posterolateral approach. This article describeds the details of this approach with pertinent literature review.

High Lumbar Disc Herniation in Achondroplasia: A Case Report / 대한정형외과학회잡지

Fifty percents of patient with achondroplasia present neurological disturbances of varying degree. Congenital narrowing of the spinal canal in achondroplastics seems to be the main cause of the cord disturbance, and there are several other causes such as prolapse of intervertebral discs, spondyloarthitic degenerative manifestations and wedging of vertebral body. Surgical treatment of the cord disturbance consist of anterior decompression with fusion and posterior decompression. We experienced L1-2 disc herniation in achondroplasia with rapid progression of neurologic symptoms and treated with posterior decompression. Two years after operation, the patient had good result.

High Lumbar Disc Herniation Treated With an Anterolateral Approach: Case Report

Approaching to high lumbar level, the width of laminar decrease and conventional laminectomy for the management of L1-2 or L2-3 disc herniation may cause fracture of inferior articular facets of L1 or L2 vertebrae. We performed anterolateral approach to preserve posterior elements(destruction of which may cause later spinal instability), for the management of high lumbar disc herniation.