Portal de Periódicos da CAPES

Extraforaminal lumbar disc herniation - Diagnosis and treatment.

1989; Volume: 38; Issue: 1 Linguagem: Inglês

10.5035/nishiseisai.38.125

1349-4333

Toshihiko Taguchi, Shinya Kawai, Hirotsugu Oda, Kenji Kido, Kiyotake Shinoda, Shigeki Yamagata, Nobuhide Shinjyou,

Spinal Fractures and Fixation Techniques

During a two-year period from January 1986 to December 1987, 54 patients underwent lumbar discectomy for herniated nucleus pulposus. Five patients (9.8%) were diagnosed as having an extraforaminal disc herniation.‹Materials› There were 3 male patients and 2 female patients. The age was 20-53 years old, the average being 36 years old. The site of nucleus pulposus were 4 cases at the L5-S1 intervertebral disc and one case at the L4-L5 intervertebral disc.‹Diagnosis› Clinically, the involved nerve root level could be easily identified but the point of compression was relatively difficult to decide. All patients were evaluated with myelography, computerized tomography, discography enhanced computerized tomography (Disco-CT) and nerve root infiltration. In all cases, myelography did not show any abnormalities. Disco-CT was very useful for accurate diagnosis of the extraforaminal disc herniation.‹Treatment› All patients had osteoplastic hemilateral laminectomy. This method was different from conventional laminectomy. To briefly reviewing this technique, the lamina is cut diagonally at the interarticular part and the spinous process is cut longitudinally with an osteotome from back to front. The lamina is removed in one piece and superior facet is cut in the medial one fourth and upper one fourth. The result of this procedure is that the extraf oraminal disc herniation can be easily identified and removed. After that, lamina is replaced and fixed with 5 silk threads.The advantages of this method are; 1) the operating area is wide and extraforaminal disc herniation can be removed safely and completely; 2) the intervertebral joints need not be sacrificed and spinal instrumentation is not necessary; 3) the posterior elements are kept intact and there will be no dead space. Follow-up study, the average being 13 months, showed good results. Osteoplastic hemilateral laminectomy is an effective method of management.