Removal of Disc Fragments from the Lumbar Spinal Canal Without Normal Anatomy Disruption
Source:The 32nd Annual Meeting of the Section on Disorders of the Spine and Peripheral Nerves.
March 2016. Orlando Florida.
David A. Ditsworth, M.D., Luis A. Lombardi, M.D.
With the common laminotomy/discectomy, including the typical so-called "minimally invasive" techniques, bone and ligamentum flavum need to be removed in order to access the spinal canal and the pathology. Depending on the size and location of the extruded fragment/s, the amount of bone removal ranges from a conservative laminotomy to a wider laminectomy with or without hemi-facetectomy. In either case, once the normal anatomy has been altered the possibility of failed back surgical syndrome increases dramatically.
We use a non-traumatic access, small tubular system and a working-channel scope which allows excellent visualization. There is no cutting through the muscle fibers and the ligamentum flavum or need for bone removal to gain access to the spinal canal. The access is achieved through a posterior interlaminar, or a purely transforaminal approach.
To determine if this method can achieve better success rates and avoid potentially deleterious long term ill effects.
We performed a retrospective analysis from 2009 up to date of 126 patients; 97 males (77%) and 29 females (23%), 16 to 76 years of age. They were all single level cases. The non-traumatic approaches were as follows: 57 (45%) posterior approach through the ligamentum flavum; 65 (52%) transforaminal approach and 4 (3%) a combination of both approaches. The results are reported utilizing the MacNAb criteria. The average follow up was 6 weeks.
Statistical analysis showed the following results: Excellent: 77.8% (n=98), Good: 19.8% (n=25), and Poor: 2.4% (n=3). The overall success rate was 97.6%. No complications were reported.
This method achieves better success rates and avoids the potentially deleterious long term ill effects of trauma that occur with typical procedures.