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.
