Extraspinal canal lumbar disectomy: Via transverse pediculotransverse process approach technique.

ABSTRACT

This study reviews the developed technique of pediculoteansverse process approach for extraspinal lumbar disectomy which performs at lateral aspect near the posterior of lumbar disc space. This technique specifies only the soft tissue operation. Thus, it is different from the conventional disectomy. The technique can avoid epidural fibrosis, that compresses nerve roots, excision of the bone at the posterior part of lumbar spine and also surgical trauma to the lumbar nerves in the spinal canal. During November 1992- October 1993, the pediculoransverse process approach technique of lumbar disectomy was performed in 33 patients who suffered lumbar disc herniation, consisted of 10 females and 23 males, with age ranged 22-59 years old. The lesions were comfirmed by MRI as contained lumbar disc herniation and no extrusion of disc material into the spinal canal. The level of the lesions were two L 3-4, twenty – four L4-5 and seven L5 S1 levels. The results were that the hossptalization were only 2-3 days. The radicular pain to the leg disappeared immediately one day postoperation. Back pain improved about 80-90 percentage at the first day after operation and no residual back pain at two week later. The sensory deficit recovered about 80-90 percentage in one day and completely recovered in 1-2 weeks. The motor power and reflex changes recovered about 2 months. No complications were found in this series except only two patients had reoperation. The first one was operated at L4-5 disc space ans had symptoms free for 3 weeks. Afterwards he suffered low back pain and radicular pain to the fight leg again. The same operative technique was performed and it was found that the retained disc material compressed the same fifth lumbar nerve root. The other one suffered again low back pain and radicular pain, after symptoms free for six months. The diagnosis was spinal stenosis at L4-5 level and decompressive total laminectomy at L4-5 was done and radicular pain was improved except the back pain still persisted. The x-ray of lumbar spine showd postlaminectomy L4-5 spondylodisthesis and his back pain could be relieved by lumbosacral support. During 8 months to 1 year and 4 months follow up, the clinical evaluation found that all of 33 patients were graded in the good results.