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Management of Extraforaminal Disk Herniation via Minimally Invasive Articular Process-Sparing Lateral Laminectomy

March 01, 2019

Contributors: Alberto Corrado Di Martino, MD, PhD; Giuseppe Geraci, MD; Antonio Mazzotti, MD; Alessandro Panciera, MD; Francesco Pardo, MD; Fabrizio Perna; Alberto Ruffilli, MD, PhD; Francesco Traina, MD, PhD; Cesare Faldini, MD; Cesare Faldini, MD

2019 AWARD WINNER Lumbar disk herniation is one of the more frequently encountered spinal diseases. It may cause pain and neurologic deficits in the lower limbs, with clinical manifestation dependent on the site of herniation. Lumbar diskectomy, which is one of the most commonly performed spinal surgeries, usually is indicated after 6 to 12 weeks of nonsurgical treatment in patients in whom pain remains severe and sensory and motor deficits persist. Extraforaminal lumbar disk herniation is uncommon, with the L4-L5 level being the most commonly involved level and the L4 root being the most frequently compressed nerve root. L4 root compression mainly results in a mixed clinical presentation with femoral and sciatic symptoms. This video presents the clinical status of a male patient with intractable low back and left lower limb pain causing tibialis anterior and quadriceps muscle impairment. The video demonstrates minimally invasive articular process-sparing lateral laminectomy performed via a standard midline incision with the patient in the lateral decubitus position. The clinical results achieved are discussed. Minimally invasive articular process-sparing lateral laminectomy is a safe, effective, and anatomically simple technique for extraforaminal lumbar diskectomy.

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