Foraminal and far lateral lumbar disc herniation: outcome of unilateral full facetectomy with instrumented fusion

IF 0.7 Q4 CLINICAL NEUROLOGY Egyptian journal of neurosurgery Pub Date : 2024-01-02 DOI:10.1186/s41984-023-00253-6
Ahmed Gabry Elnaggar, Hosam Abdel-Azim Habib
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Abstract

Far lateral lumbar disc herniation is a clinical condition characterized by nerve root compression out of the spinal canal, in its extraforaminal/extracanalicular course at the inferior or lateral aspect of the facet joint. To analyze the effect of unilateral full facetectomy with instrumented fusion in management of foraminal and far lateral lumbar disc herniation. This retrospective trial carried out on 34 cases (24 males, 10 females) aged from 27 to 68, with mean value of 49 years who were entered to the Neurosurgery Department, Menoufia University Hospital from January 2018 and January 2022. All patients suffered from foraminal and/or far lateral lumbar disc herniation and were treated with unilateral full facetectomy with instrumented fusion. The herniation level was at L2-3, L3-4, L4-5, and L5-S1 in 2, 10, 18, and 4 patients, respectively. Overall, the mean preoperative VAS score decreased from 8.6 to 2.3 in the short-term. When the long-term functional outcome following surgery was analyzed according to the MacNab Criteria, the recovery was excellent, good, fair, and poor in 26, 8, 0, and 0, respectively. Full facetectomy ± laminectomy technique provides direct visualization of the complete course of the nerve root extending far laterally to avoid missed disc fragments and protect the nerve root from inadvertent trauma. Pedicle fixation for stabilization following full facetectomy has been indicated to avoid postoperative pain syndromes due to `micro-instability'.
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椎间孔和远侧腰椎间盘突出症:单侧全椎面切除加器械融合术的疗效
远外侧腰椎间盘突出症是一种临床病症,其特征是神经根在椎间孔外/椎间孔外的下侧或外侧面上受到压迫。分析单侧全椎面切除术与器械融合术在治疗椎间孔和远侧腰椎间盘突出症中的效果。这项回顾性试验的对象是梅努菲亚大学医院神经外科于2018年1月至2022年1月收治的34例患者(男24例,女10例),年龄在27岁至68岁之间,平均年龄为49岁。所有患者均患有椎间孔和/或远外侧腰椎间盘突出症,均接受了单侧全椎面切除术加器械融合术治疗。2、10、18和4名患者的椎间盘突出水平分别为L2-3、L3-4、L4-5和L5-S1。总体而言,术前平均 VAS 评分在短期内从 8.6 分降至 2.3 分。根据 MacNab 标准分析术后的长期功能效果时,26 例患者的恢复情况分别为优、良、一般和差,8 例、0 例和 0 例。全椎板切除术±椎板切除术可直接观察到神经根的完整走向,并向外侧延伸,避免遗漏椎间盘碎片,保护神经根不受意外创伤。全椎板切除术后进行椎弓根固定以保持稳定,可避免因 "微不稳定 "导致的术后疼痛综合症。
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