Disc Fragment Herniectomy Through a Facet Joint Quadrantectomy for Extraforaminal Lumbar Herniation: Technique and Results

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• 作者：Laurens Dereymaeker¹ ; Raf Brouns² ; Patrick Herregodts¹ ; Peter Marië ; n³ ; ⁴ ; Ann De Smedt² ; Mike Huylebrouck¹ ; Johnny Duerinck¹ ; Jean D'Haens¹ ; Maarten Moens¹ ; ^{mtmoens@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Extraforaminal ; Facet joint quadrantectomy ; Lumbar disc herniation
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：85
• 期：Complete
• 页码：228-235
• 全文大小：3271 K

文摘

Extraforaminal lumbar disc herniation (EFLDH) accounts for 7%–12% of all lumbar disc herniations. We report on a surgical technique for EFLDH, which requires only minimal resection of the facet joint and also allows access to the preforaminal space, if necessary.

Methods

The medical records of 61 consecutive patients treated with disc fragment herniectomy through a facet joint quadrantectomy for EFLDH at the Universitair Ziekenhuis Brussel were critically evaluated with respect to preoperative clinical signs and symptoms, surgery-related complications and outcome at 6 weeks after intervention. Patient satisfaction after the surgery was evaluated using the MacNab classification.

Results

The prevalence of leg pain decreased from 100% before the intervention to 19.7% at follow-up. Only 9 patients (14.8%) suffered from residual motor deficit at follow-up, compared with 37 patients (60.7%) in the preoperative situation. The postoperative improvement was highly significant for all parameters (P < 0.0001) and this evolution is also reflected in the MacNab classification showing 62.3% excellent, 23.0% good, 13.1% fair, and only 1.6% poor satisfaction. Using logistic regression analysis, only the presence of a preoperative sensory deficit was found to be an independent predictor for excellent patient satisfaction on the MacNab classification.

Conclusions

Disc fragment herniectomy through a facet joint quadrantectomy for EFLDH is a safe and minimal invasive technique resulting in very satisfactory results. Preservation of facet joint stability and the possibility to convert to a classic approach to reach for preforaminal components, if necessary, are major advantages of this technique.