Article
Full-endoscopic uniportal transforaminal decompression of the ventral epidural space in sequestered disc prolapses using new extreme lateral access – Prospective results of 734 patients
Die vollendoskopische uniportale transforaminale Dekompression des ventralen Epiduralraumes bei sequestrierten Bandscheibenvorfällen mittels eines neuen, extrem lateralen Zuganges. Prospektive Ergebnisse von 734 Patienten
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Authors
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Martin Komp
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Klinik für Orthopädie am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke, St. Anna-Hospital Herne
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S. Ruetten
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Klinik für Orthopädie am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke, St. Anna-Hospital Herne
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G. Godolias
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Klinik für Orthopädie am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke, St. Anna-Hospital Herne
| Published: | April 23, 2004 |
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Outline
Text
Objective
The endoscopic transforaminal operation with the usual posterolateral access does not permit working in the ventral epidural space because of the cygoapophyseal joints. This is, however, prerequisite to decompression in disk prolapse. What possibilities are offered by the new extreme lateral access in full-endoscopic uniportal transforaminal sequestrotomy?
Methods
In 2000 to 2002, two surgeons operated on 834 patients with medial and mediolateral sequestered disk prolapse using the surgical procedure cited. The new extreme lateral access was established to enable tangential reaching of the ventral epidural space. The levels of operation were L1/2 in 24 cases, L 2/3 in 63, L3/4 in 189, L 4/5 in 553 and L5/S1 in 5 cases. In addition to special instruments, active moveable bipolar high-frequency electrodes and the holmium:YAG laser in sidefire technique were used. The prospective follow-up period lasted 12 months. Seven hundred and thirty-four patients (88%) could be followed.
Results
No severe intraoperative or postoperative complication occurred. The meantime of operation was 27 minutes. Sequestered disc material could be excised in all cases. The maximum hospitalization was 2 days. Five hundred and ninety-four patients (81%) reported no further radicular leg pain, 103 patients (14%) reported transient persistence. Thirty-seven patients (5%) reported no essential improvement. There was no case of deterioration. No post-diskotomy syndrome was observed. Prolapse recurred in 44 patients (6 %); 37 of these were operated using the same technique, 7 in open procedure. Extreme lateral access was required to reach the ventral epidural space sufficiently.
Conclusions
The extreme lateral access for operation of sequestered disc prolapses in a transforaminal technique is a sufficient and safe procedure, and is required to reach the ventral epidural space. There are advantages over standard nucleotomy. Anatomical problems arise here because of the pelvis at level L5/S1 and in far sequestered material. The patient must be given explicit information about the recurrence of prolapse. In combination with interlaminar approach a wide spectrum in full-endoscopic uniportal operations now exists.
