Japanese Journal of Neurosurgery
Online ISSN : 2187-3100
Print ISSN : 0917-950X
ISSN-L : 0917-950X
REVIEW ARTICLES
Surgical Approaches to the Lumbar Midline Huge Disc Herniation
Daisuke AraiJunya HanakitaToshiyuki TakahashiMizuki WatanabeTakashi TominagaTaigo KawaokaKyohei Horikawa
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JOURNAL OPEN ACCESS

2014 Volume 23 Issue 2 Pages 128-135

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Abstract
  It is difficult to resect a lumbar midline disc herniation, especially a lumbar midline huge disc herniation, using so-called Love procedure. Various surgical complications, such as root injury due to excessive retraction or dural tears as a result of blind operations have been reported. We herein describe four surgical methods for a lumbar midline huge disc herniation, which we have been performing for seven years.
  In this series, we defined a lumbar midline huge disc herniation as a herniated mass having the following two characteristics.
  1) A ratio of the maximum diameter of the mass to the diameter from posterior surface of the vertebral column to the dorsal side of the dural sac >70%.
  2) A C-shaped dural sac formed due to the compression from the herniated mass.
  We retrospectively investigated 540 patients who underwent an operation for a lumbar disc herniation in Spinal Disorders Center, Fujieda Heisei Memorial Hospital from January 2005 to September 2012, and identified 12 patients (nine males, three females) meeting our definition of a lumbar midline huge disc herniation.
  The surgical methods used were : unilateral partial hemilaminectomy (five cases), bilateral laminectomy (five cases), a transforaminal approach with pedicle screw fixation (one case) and a transdural approach (one case).
  Each option has advantages and disadvantages. An appropriate surgical option should be chosen after evaluating the patient in terms of lumbar level, deviation of dural sac and cauda equine rootlets and the possibility of adhesion with the dura mater.
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© 2014 The Japanese Congress of Neurological Surgeons

この記事はクリエイティブ・コモンズ [表示 - 非営利 - 改変禁止 4.0 国際]ライセンスの下に提供されています。
https://creativecommons.org/licenses/by-nc-nd/4.0/deed.ja
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