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KMID : 1040920160010010027
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Journal of Minimally Invasive Spine Surgery and Technique
2016 Volume.1 No. 1 p.27 ~ p.31
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Key-hole Laminotomy (Translaminar Microsurgical Approach) for Upper Lumbar Herniated Disc
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Son Seong
Lee Sang-Gu
Kim Woo-Kyung
Ahn Yong
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Abstract
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Objective: The conventional microsurgical interlaminar approach for upper lumbar disc herniation (LDH) can increase the risk of postoperative spinal instability due to excessive laminectomy and/or facetectomy. The authors present a key-hole laminotomy (microsurgical translaminar approach) for upper LDH, which allows less destructive laminotomy, and review the results of this surgical technique.
Methods: Between 2007 and 2014, 20 patients underwent single level discectomy in the upper lumbar spine (L1-2 or L2-3) using a microsurgical translaminar approach. Mean patient age was 58.0±12.0 years and minimum follow-up was 1.0 years. A retrospective review of clinical and radiological data was conducted.
Results: Back pain and leg pain were improved from an average of 4.9±1.1 and 8.3±0.9 to 0.9±0.7 and 0.9±1.6 at 1-year postoperatively (p<0.001). According to Odom’s criteria, symptom improvement was significant at 1-year follow-up visits. Disc height at the operated level was decreased from 8.9±1.9 to 8.2±2.3 mm (p=0.043), and, total lumbar lordotic angle was increased from 26.8±10.8 to 36.6±10.6° (p=0.021). Excepting two case of post-operative additional nerve root block for remnant leg pain and recurrence there were no surgical complications.
Conclusion: The key-hole laminotomy for upper LDH achieved favorable clinical outcomes without iatrogenic instability. The described key-hole laminotomy provides a safe, effective alternative to the conventional interlaminar approach for upper LDH.
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KEYWORD
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Upper lumbar spine, Disc herniation, Microsurgical translaminar approach
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