Surgical discectomy for lumbar disc herniation: Surgical techniques

Abstract

Discectomy for lumbar discal herniation is the most commonly performed spinal surgery. The basic principle of the various techniques is to relieve the nerve root compression induced by the herniation. Initially, the approach was a unilateral posterior 5-cm incision: the multifidus was detached from the vertebra, giving access through an interlaminar space in case of posterolateral herniation; an alternative paraspinal approach was used for extraforaminal herniation. Over the past 30 years, many technical improvements have decreased operative trauma by reducing incision size, thereby reducing postoperative pain and hospital stay and time off work, while improving clinical outcome. Magnification and illumination systems by microscope and endoscope have been introduced to enable minimally invasive techniques. Several comparative studies have analyzed the clinical results of these various techniques. Although the methodology of most of these studies is debatable, all approaches seem to provide clinical outcomes of similar quality. At all events, minimally invasive techniques reduce hospital stay. While technical proficiency is essential, the final result depends on strict compliance with a prerequisite for surgical indication: close correlation between clinical symptoms and radiological findings. It is essential to discuss the risk/benefit ratio and explain the pros and cons of the recommended technique to the patient.

Surgical Outcome of Fusion in Recurrent Lumbar Disc Herniation

“…The rate of recurrent disc herniation after lumbar discectomy is 5% to 15% [5]. So that, recurrent lumbar disc herniation (RLDH) is a major cause of surgical failure [7], the recurrent disc herniation is the major cause of the failed back surgery syndrome [8]. The optimal surgical approach (simple discectomy with or without fusion of the affected segment) for recurrent disc herniation remains a subject of controversy [9] [10].…”

Functional Outcome of Patients with Lumbar Intervertebral Disc Herniation after Minimally Invasive Microdiscectomy

“…Correct indication, expertise of the surgeon and the patients informed consent remain the key factor in deciding the technique. 15 A good control of the indication for surgery is the basis, accurate positioning is the prerequisite, protecting the nerve is the key, complete discectomy is the guarantee, full decompression is the fundamention and all the factors work together to make minimally invasive perfect.…”

The Outcome of Minimally Invasive Discectomy in Single Level Lumbar Disc Prolapse

“…This maneuver allows the EHL to exert its maximal strength in isolation. To assess the strength of the FHL, the patient was in supine position with the ankle in 30˚ planter flexion, the metatarsophalangeal joint was stabilized by one hand (left hand) and holding the proximal phalanx of the big toe in neutral position, the distal phalanx of the big toe was placed in extention by the other hand (right hand) and then we instruct the patient to do big toe flexion [16].…”