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How to Perform a Lumbar Discectomy

January 01, 2012

Contributors: Mohammadreza Chehrassan, MD; Francesco Acri, MD; Maria Teresa Miscione, MD; Valentina Persiani, MD; Paola Capra, MD; Camilla Pungetti, MD; Antonio Mazzotti, MD; Sandro Giannini, MD; Cesare Faldini, MD; Cesare Faldini, MD

Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.
Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.

Herniated disc syndrome in the lumbar spine is the consequence of a conflict between a spinal root or cauda equina and a fragment of nucleus pulposus that has migrated through the annulus fibrosus. The rapid compression of one or more spinal roots produces severe pain and/or sensitive or motor deficits. Lumbar discectomy is usually indicated after 6 to 12 weeks of conservative treatment if pain remains intractable or severe sensitive or motor deficits persist. The aim of this video is to show the lumbar discectomy of a 36-year-old patient, who suffered from 12 weeks of intractable low-back pain associated with right S1 root radiculopathy. We made a 3-cm median skin incision from L5 to S1 and detached the paravertebral muscles from the right lamina of L5 and S1. Then we performed a small laminectomy of right L5, sparing the lateral articular process and the pars interarticularis. Removal of the ligamentum flavum in the interlaminal space exposed the dural sac and the S1 exiting root. After identifying the herniated fragment, we carefully removed it. Throughout, we were careful to extract the disc fragments in order to decrease the risk of disc herniation or fragmenting that would leave residual fragments inaccessible. The herniated disc syndrome in the lumbar spine can be successfully treated by discectomy. This procedure leaves the articular facet intact and minimizes bone removal.

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