Three-Years Outcome of Microdiscectomy via Paramedian Approach for Lumbar Foraminal or Extraforaminal Disc Herniations in Elderly Patients over 65 Years Old

Abstract

ObjectiveLumbar foraminal or extraforaminal disc herniations (FEFDH) have unusual clinical features and higher incidence in elderly patients compared to usual intraspinal canal disc herniations. We evaluated the efficacy of microdiscectomy via paramedian approach for lumbar FEFDH in elderly patients over the age of 65.MethodsRetrospective study was performed in 68 patients over the age of 65 (23 male and 45 female patients; 71.46±3.87 years) who underwent microdiscectomy via paramedian approach for unilateral lumbar FEFDH causing sciatica. The radiological factors including degree of slippage, presence of instability, disc height, and degree of disc degeneration; pain and functional status by the means of visual analogue scale score, Oswestry Disability Index score, and Macnab classification were analyzed preoperatively and during the postoperative follow-up period of 3 years to evaluate the efficacy of the surgical treatment.ResultsPain and functional status improved according to short- and long-term follow-up evaluations after surgery. Radiological changes following surgery, which can be understood as structural deteriorations and deformations, did not represent patient condition. Nine patients underwent additional surgery due to sustained or recurring leg pain of aggravation of back pain, and fusion surgery was required for 3 patients. Degree of preoperative slippage was the only statistically significant factor related to additional surgery (p<0.05).ConclusionMicrodiscectomy via paramedian approach for FEFDH may be a good surgical alternative in elderly patients. Radiological changes after surgery did not show a concordance with patients' actual functional status. The excessive preoperative slippage tended to lead to unfavorable result after surgery and was associated with additional surgery.

Microstructural changes are coincident with the improvement of clinical symptoms in surgically treated compressed nerve roots

“…For patients with LDH who do not achieve good recovery with conservative treatment, surgical interventions, which include micro endoscopic discectomy, discectomy with insertion of pedicle screws, and percutaneous transforaminal endoscopic discectomy, should be considered 16 17 18 . However, the microstructural improvement of compressed nerve roots is critical to ensure surgical success.…”

The Paraspinal Wiltse Approach to the Lumbar Spine: A Literature Review and Anatomical Guide

“…For discectomies, the approach is very useful when the disc herniation is more lateral, and in foraminal and extraforaminal herniations (Cho et al, 2016;Yeo et al, 2016). This is also true for removal of foraminal and extraforaminal tumors (Ngerageza et al, 2015).…”

Clinical signs, MRI findings and long‐term outcomes of foraminal and far lateral thoracolumbar intervertebral disc herniations in dogs

“…4,5,9 The diagnosis of foraminal or far lateral disc extrusions can be challenging as most cases require advanced imaging techniques, such as MRI or CT. 10 The clinical presentation, MRI features and outcome after medical and surgical treatment of intervertebral foraminal extrusions have been previously reported in the cervical region in dogs. 11 Although their prevalence in the lumbar region has been reported to range from 0.7% to 11.7% in the human literature, 12 they have seldom been described affecting this region in dogs. 5 Two case reports have previously described far lateral extrusions in the vertebral column of dogs treated surgically.…”