Journal articles: 'Interlaminar contralateral approach'

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Baek, Jungwon, Jia Kim, Seunghee Cho, Yujin Jeong, and Eung Don Kim. "Novel method for modified interlaminar approach using contralateral oblique view: A technical suggestion." PLOS ONE 16, no. 1 (January 6, 2021): e0244992. http://dx.doi.org/10.1371/journal.pone.0244992.

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A modified interlaminar (MIL) approach has been proposed for improved accessibility to the target epidural space. However, even with fluoroscopic guidance, uncertainty about the distance between the needle tip and the epidural space can remain. Using the contralateral oblique (CLO) view, determination of the epidural space can be easier with clearer identification of the interlaminar opening. We inserted the needle at the midpoint of the interlaminar opening on the fluoroscopic anteroposterior (AP) view and made the needle oriented toward the pedicle of the target side. Then, CLO view was created by rotating the intensifier approximately 45 degrees to the contralateral side of the target. Through the CLO view, the ventral interlaminar line (VILL) was confirmed and the needle was able to enter the epidural space more easily. The medical records of 29 patients who were conducted MIL approach using CLO view were retrospectively analyzed to evaluate the effectiveness and safety of this procedure. The accessibility to the ventral epidural space was 93.1%. There was no procedure-related complication. Using CLO view, uncertainty can be reduced during the MIL approach, which in turn shortens procedure time and improves safety.

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Kim, Chan-Sik, Yeon-Jin Moon, Jae Won Kim, Dong-Min Hyun, Shill Lee Son, Jin-Woo Shin, Doo-Hwan Kim, Seong-Soo Choi, and Myong-Hwan Karm. "Transforaminal Epidural Balloon Adhesiolysis via a Contralateral Interlaminar Retrograde Foraminal Approach: A Retrospective Analysis and Technical Considerations." Journal of Clinical Medicine 9, no. 4 (April 1, 2020): 981. http://dx.doi.org/10.3390/jcm9040981.

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Several treatment modalities have been proposed for foraminal stenosis, but the treatment options remain unsatisfactory. Previous studies have shown that transforaminal balloon adhesiolysis may be effective in patients with refractory lumbar foraminal stenosis. However, in patients with a high iliac crest, balloon catheter insertion may be difficult via a conventional transforaminal approach (particularly targeting the L5–S1 foramen). It has been reported that an epidural catheter can be placed easily by a contralateral interlaminar retrograde foraminal approach. Therefore, we applied this approach to L5–S1 transforaminal balloon adhesiolysis in patients with a high iliac crest. We retrospectively analyzed data from 22 patients who underwent combined epidural adhesiolysis and balloon decompression (balloon adhesiolysis) using the novel foraminal balloon catheter via a contralateral interlaminar retrograde foraminal approach. The pain intensity significantly decreased over the three-month period after balloon adhesiolysis (p < 0.001). There were no complications associated with the balloon procedure. The present study suggests that balloon adhesiolysis for L5-S1 foramen via a contralateral interlaminar retrograde foraminal approach may be an effective alternative for patients with a high iliac crest and refractory lumbar radicular pain due to lumbar foraminal stenosis. In addition, detailed procedural aspects are described here.

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Perez-Roman, Roberto J., and Michael Y. Wang. "Endoscopic Interlaminar Approach for Lumbar 4/5 Ipsilateral and Contralateral Decompression: 2-Dimensional Operative Video." Operative Neurosurgery 21, no. 3 (June 7, 2021): E236. http://dx.doi.org/10.1093/ons/opab183.

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Abstract Lumbar radiculopathy often results from direct compression of the exiting nerve roots. This may be caused mainly by spondylotic changes with any contribution from components like a herniated disc, facet overgrowth, and ligamentum flavum hypertrophy, or any combination of them. There are a wide range of surgical treatments directed at decompressing the neural elements. Over the last decade, endoscopic spine surgery has gained popular interest because of potential benefits, including decreased bony removal, less muscle disruption, and enhanced visualization.1 A unilateral endoscopic surgical approach can accomplish an effective bilateral decompression using the ipsilateral-contralateral technique.2 This method allows for addressing both central and bilateral recess stenoses. We present a case of a 48-yr-old female with persistent bilateral lower extremity radicular pain worse on the left side with severe lumbar 4/5 stenosis and a left-sided synovial cyst causing significant foraminal narrowing. This 2-dimensional video illustrates the technique used for an endoscopic interlaminar approach for lumbar 4/5 ipsilateral and contralateral decompression. We highlight key elements regarding the positioning, workflow, and surgical technique to successfully perform this approach. Patient consented to the procedure.

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Lee, Byeongcheol, Sang Eun Lee, Yong Han Kim, Jae Hong Park, Ki Hwa Lee, Eunsu Kang, Sehun Kim, Jaehwan Kim, and Daeseok Oh. "Evaluation of Contrast Flow Patterns with Cervical Interlaminar Epidural Injection: Comparison of Midline and Paramedian Approaches." Medicina 57, no. 1 (December 24, 2020): 8. http://dx.doi.org/10.3390/medicina57010008.

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Background and objectives: The purpose of this study was to compare and to analyze contrast spread patterns between the paramedian and midline approaches to cervical interlaminar epidural injection (CIEI). Materials and Methods: We retrospectively enrolled 84 CIEI cases that had been performed for unilateral cervical spinal pain from April 2019 to April 2020. After 3 mL of contrast had been injected into the epidural space, fluoroscopic images were obtained. The CIEI was divided into a midline (Group M, n = 42) and a paramedian (Group P, n = 42) approach by anteroposterior imaging. The P Group was classified into a more medial (Group Pm, n = 26) and a more lateral (Group Pl, n = 16) group. Using ImageJ on an anteroposterior image, we assessed the grayscale brightness ratio of the ipsilateral or contralateral side of the vertebral body as well as the intervertebral disc space one level just above the needle location. We identified the dispersion of contrast into the ventral epidural space. Results: The grayscale brightness ratio was significantly higher in Group P than in Group M (p < 0.001). The incidence of ventral epidural spread in Group M was 57.1% versus 88.1% in Group P, which was significantly different (p = 0.001). Conclusions: The fluoroscopic CIEI finding in the paramedian approach predominantly showed an excellent delivery of the injectate to the ipsilateral side in comparison to the contralateral side. This showed a greater advantage in delivery toward ventral epidural space as compared to the midline approach.

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Kim, Ji Yeon, Hyeun Sung Kim, Jun Bok Jeon, Jun Hyung Lee, Jun Hwan Park, and Il-Tae Jang. "The Novel Technique of Uniportal Endoscopic Interlaminar Contralateral Approach for Coexisting L5-S1 Lateral Recess, Foraminal, and Extraforaminal Stenosis and Its Clinical Outcomes." Journal of Clinical Medicine 10, no. 7 (March 26, 2021): 1364. http://dx.doi.org/10.3390/jcm10071364.

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Background: Multifocal intra-and-extraspinal lumbar stenotic lesions could be decompressed with one endoscopic surgical approach, which has the advantages of functional structure preservation, technical efficacy, and safety. Methods: A retrospective study was performed on 48 patients who underwent uniportal endoscopic contralateral approach due to coexisting lateral recess, foraminal, and extraforaminal stenosis at the L5-S1 level. Foraminal stenosis grade and postoperative dysesthesia (POD) were analyzed. Visual analog scale (VAS) pain scores, modified Oswestry Disability Index (ODI) scores, and MacNab criteria for evaluating pain disability and response were analyzed. Results: The foraminal stenosis grade of the treated spinal levels was grade 1 (n = 16, 33%), grade 2 (n = 20, 42%), and grade 3 (n = 12, 25%). The rate of occurrence of POD grade 2 and above, which may be related to intraoperative dorsal root ganglion (DRG) retraction injury, was revealed to be 4.2% (two with grade 2, none with grade 3). The patients showed favorable clinical outcomes. Conclusions: Uniportal endoscopic interlaminar contralateral approach is an effective procedure to resolve combined stenosis (lateral recess, foraminal, and extraforaminal region) with one surgical approach at the L5-S1 level. It may be a minimal DRG retracting and facet joint preserving procedure in foraminal and extraforaminal decompression.

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Zekaj, Edvin, Claudia Menghetti, Christian Saleh, Alessandra Isidori, AlbertoR Bona, Enrico Aimar, and Domenico Servello. "Contralateral interlaminar approach for intraforaminal lumbar degenerative disease with special emphasis on L5-S1 level: A technical note." Surgical Neurology International 7, no. 1 (2016): 88. http://dx.doi.org/10.4103/2152-7806.191024.

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Choi, Kyung-Chul, Jung Lee, Dong Lee, Choon Park, and Jin-Sung Kim. "Combination of Transforaminal and Interlaminar Percutaneous Endoscopic Lumbar Diskectomy for Extensive Down-migrated Disk Herniation." Journal of Neurological Surgery Part A: Central European Neurosurgery 79, no. 01 (April 28, 2017): 060–65. http://dx.doi.org/10.1055/s-0037-1601875.

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Background and Study Aims The technique and instrumentation of percutaneous endoscopic lumbar diskectomy (PELD) have significantly improved. Thus its indications have been gradually expanding. Down-migrated disk, in particular, is regarded inaccessible by rigid instrumentation due to poor visualization and limited accessibility. We introduce a combination of transforaminal and interlaminar PELD for extensive down-migrated disk herniation at the L4–L5 level. Patients and Methods In the first case, a 48-year-old man had left L5 radicular pain. Magnetic resonance imaging (MRI) showed that L4–L5 disk herniation extended to the L5 lower end-plate level. In the second case, a 39-year-old man presented with right L5 and S1 radiculopathy. MRI showed right huge extensive down-migrated disk herniation from the L4–L5 disk space to the S1 pedicle level. Back pain and leg pain were measured using the visual analog scale (VAS). In the first case, transforaminal PELD with foraminoplasty removed the disk fragment from the L4–L5 disk space to the mid-L5 pedicle level. Interlaminar PELD removed the remaining disk below the mid-L5 pedicle. In the second case, first, contralateral (left) transforaminal PELD at L4–L5 removed disk fragments located at the subannular and subligamentous area as well as the upper part of the down-migrated disk herniation. Second, interlaminar PELD via an ipsilateral (right) L5–S1 interlaminar space removed the remains of the extensively down-migrated disk herniation. Results In the first case, the VAS scores for back and leg pain were improved from 6 and 8 to 2 and 1, respectively. Postoperative MRI showed complete removal of the disk fragment. In the second case, the VAS scores for back and leg pain improved from 7 and 9 to 3 and 1, respectively, after PELD. Postoperative MRI showed complete removal of a huge disk herniation. Both patients were discharged the day after PELD. Follow-up examinations showed no recurrence. Conclusions It is difficult to remove entire disk fragments using only a transforaminal or interlaminar approach for extensive down-migrated disk herniation. Therefore a combination of transforaminal and interlaminar PELD may be effective for extensive down-migrated disk herniation at L4–L5.

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Gill, Jatinder, Thomas Simopoulos, Vwaire Orhurhu, Jyotsna Nagda, and Moris Aner. "Lumbar Epidural Contrast Spread Patterns for the Interlaminar Approach: Three-Dimensional Analysis Using Antero-Posterior, Lateral, and Contralateral Oblique Views." Pain Medicine 21, no. 4 (October 14, 2019): 747–56. http://dx.doi.org/10.1093/pm/pnz256.

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Abstract Objective To describe and analyze lumbar epidural contrast spread patterns in antero-posterior (AP), lateral, and contralateral oblique (CLO) views. Methods Lumbar epidural contrast spread patterns after interlaminar injection were prospectively collected in AP, lateral, and several CLO views and analyzed for multiple variables; three-dimensional mapping was also performed. Results Epidural contrast patterns were prospectively analyzed in 28 subjects. The median volume of contrast injected was 2 mL; the AP view was more sensitive than the lateral view to detect foraminal uptake (13/28, 46%, 95% confidence interval [CI] = 27–66%, vs 7/28, 25%, 95% CI = 11–45% subjects). CLO view demonstrated the most consistent location for epidural contrast spread, with contrast contacting the ventral laminar margin in 28/28 (100%, 95% CI = 87–100%) patients. The most common location of contrast spread in the lateral view was at the facet joint lucency, with only 8/28 (29%, 95% CI = 13%–49%) subjects showing contrast contacting the spinolaminar junction. Lateral view was more sensitive than the CLO view in ventral epidural contrast spread detection. The extent and distribution of the spread did not bear any relationship to the volume injected or to the needle location in AP view. Conclusions CLO view provides the most consistent landmark for lumbar epidural contrast spread, and lateral view is most suited to confirming ventral epidural spread. The AP view may be the most optimal for determining target access when considering access to the dorsal root ganglia; in an individual patient, the volume injected and needle location in AP view do not reliably predict target access. The volume to be injected and the need to re-access or obtain multisite access must be prospectively determined, based upon observation of the spread.

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Kim, Hyeun Sung, Ravindra Singh, Nitin Maruti Adsul, Sung Woon Oh, Jung Hoon Noh, and IL Tae Jang. "Management of Root-Level Double Crush: Case Report with Technical Notes on Contralateral Interlaminar Foraminotomy with Full Endoscopic Uniportal Approach." World Neurosurgery 122 (February 2019): 505–7. http://dx.doi.org/10.1016/j.wneu.2018.11.110.

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Lee, Keun, Hyeun-Sung Kim, Jee-Soo Jang, Yong-Hun Pee, Jin-Uk Kim, Jun-Ho Lee, and Il-Tae Jang. "Percutaneous Endoscopic Lumbar Discectomy for L5-S1 Foraminal Disc Herniation with Superior Migration using Contralateral Interlaminar Approach: A Technical Case Report." Journal of Minimally Invasive Spine Surgery and Technique 1, no. 1 (September 30, 2016): 40–43. http://dx.doi.org/10.21182/jmisst.2016.00059.

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Kim, Hyeun Sung, Ravish Patel, Byapak Paudel, Jee-Soo Jang, Il-Tae Jang, Seong-Hoon Oh, Jae Eun Park, and Sol Lee. "Early Outcomes of Endoscopic Contralateral Foraminal and Lateral Recess Decompression via an Interlaminar Approach in Patients with Unilateral Radiculopathy from Unilateral Foraminal Stenosis." World Neurosurgery 108 (December 2017): 763–73. http://dx.doi.org/10.1016/j.wneu.2017.09.018.

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Akbary, Kutbuddin, Jin-Sung Kim, Cheul Woong Park, Su Gi Jun, and Jae Ha Hwang. "Biportal Endoscopic Decompression of Exiting and Traversing Nerve Roots Through a Single Interlaminar Window Using a Contralateral Approach: Technical Feasibilities and Morphometric Changes of the Lumbar Canal and Foramen." World Neurosurgery 117 (September 2018): 153–61. http://dx.doi.org/10.1016/j.wneu.2018.05.111.

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Al-Kaisy, Adnan. "Effectiveness of “Transgrade” Epidural Technique for Dorsal Root Ganglion Stimulation. A Retrospective, Single-Center, Case Series for Chronic Focal Neuropathic Pain." November 2019 6, no. 22;6 (November 14, 2019): 601–11. http://dx.doi.org/10.36076/ppj/2019.22.601.

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Background: The recent interest in targeting the dorsal root ganglion (DRG) has led to the development of new techniques of electrode placement. In this article, we describe a new “Transgrade” approach to the DRG, accessing the contralateral interlaminar space and steering the lead out the opposite foramen. Objectives: The purpose of this study was to evaluate the Transgrade technique to the DRG in the management of focal neuropathic pain, predominately complex regional pain syndrome in terms of efficacy and safety. Study Design: A retrospective, observational review of all patients selected for DRG stimulation using the Transgrade technique to the DRG. Setting: Pain Management and Neuromodulation Centre, Guys and St. Thomas NHS Foundation Trust, London, United Kingdom. Methods: Data were taken from a hospital password-protected database. All patients were contacted by telephone for Numeric Rating Scale (NRS-11) score, Patient Global Impression of Change (PGIC) score, and complications. A patient responder was defined as having a PGIC score of 6 or 7, and a 2-point reduction from baseline NRS-11. Results: A total of 39 patients (46% women) with a mean age of 46 years (± 2) underwent a trial of DRG stimulation that resulted in an implantation rate of 82% (32 of 39). The responder rates, according to NRS-11 and PGIC results, were 87% (28 of 32) at 6 weeks and 66% (21 of 32) at a mean of 18 months (± 1.8) follow-up. Pocket pain was the most common complication, occurring in 7 of 32 (22%) patients, and the lead migration rate was 3 out of 57 leads placed (5.2%). A burst protocol was the favored method of stimulation in the majority of patients, 25 of 32 (78%). Limitations: Retrospective nature of design, small sample size. Conclusions: The Transgrade technique of placing DRG leads offers an alternative method that is safe and effective. New methods of stimulation to the DRG offer more choice and potentially better efficacy for patients with chronic neuropathic pain.

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Deng, Zhong-Liang. "Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated Lumbar Disc Herniation." January 2018 1, no. 21;1 (January 14, 2017): E75—E84. http://dx.doi.org/10.36076/ppj.2017.1.e75.

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Background: Percutaneous endoscopic lumbar discectomy (PELD) has been growing in popularity for the treatment of lumbar disc herniation (LDH) due to its irreplaceable advantages over conventional open surgery. Compared with common lumbar disc herniations, discectomy of highly migrated LDH by PELD is known to be very difficult. Highly migrated lumbar disc herniation has long been a challenge for its specific characteristics. Three approaches for PELD have been applied to access a highly migrated LDH, including an interlaminar approach (IL), transforaminal approach (TF), and contralateral transforaminal approach (CTF). However, none of the existing research has systematically described the selection of the most appropriate procedure from the 3 approaches or the individualization of an operative procedure in different cases. Objectives: The purpose of this study was to present a detailed surgical approach selection and individualization of procedure in the treatment of highly migrated LDH with PELD. We also mean to compare the outcomes of patients with highly migrated LDH treated with PELD by the 3 approaches. Study Design: Single-center retrospective observational study. Setting: An interventional pain management practice, a medical center, major metropolitan city, China. Methods: In our retrospective analysis between March 2011 and March 2013, 73 patients with single level highly migrated LDH received PELD. Clinical outcomes were assessed with the visual analogue scale (VAS) score, the modified MacNab criteria, and the Oswestry disability index (ODI). Relevant data such as operation duration and fluoroscopy frequency of the 3 operative approaches were recorded. Results: The mean operating time of IL was 56 minutes, compared with 64 minutes for TF and 112 minutes for CTF. The mean intraoperative fluoroscopy times were 5.5 for IL, 9.7 for TF, and 14.6 for CTF. In each group, the mean VAS and ODI after surgery and 3 months after surgery improved dramatically compared with preoperative counterparts. However, the difference between postoperative results and the results 3 months after surgery was not significant (P > 0.05). The overall excellent rate was 90.4% according to the modified MacNab criteria; there was no significant statistical difference between the 3 operative routes. Operative complications occurred in 3 patients (2 after IL and one after CTF, 3 of 73, 4.1%). Limitations: This study is limited by its sample size. Conclusion: In our research, PELD with all 3 approaches was similarly effective to highly migrated disc herniation. The CTF approach required the longest operation duration and the most intraoperative times. On the contrary, the least operation time and radiographfrequency was required with the IL approach. In addition, we came to a conclusion of surgery approach selection when it comes to varied HM-LDH. Key words: Highly migrated, lumbar disc herniation, percutaneous endoscopic lumbar discectomy, minimally invasive treatment Pain Physician 2017;

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Candido, Kenneth D. "Concordant Pressure Paresthesia During Interlaminar Lumbar Epidural Steroid Injections Correlates with Pain Relief in Patients with Unilateral Radicular Pain." Pain Physician 5;16, no. 5;9 (September 14, 2013): 497–511. http://dx.doi.org/10.36076/ppj.2013/16/497.

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Background: Transforaminal and interlaminar epidural steroid injections are commonly used interventional pain management procedures in the treatment of radicular low back pain. Even though several studies have shown that transforaminal injections provide enhanced short-term outcomes in patients with radicular and low back pain, they have also been associated with a higher incidence of unintentional intravascular injection and often dire consequences than have interlaminar injections. Objectives: We compared 2 different approaches, midline and lateral parasagittal, of lumbar interlaminar epidural steroid injection (LESI) in patients with unilateral lumbosacral radiculopathic pain. We also tested the role of concordant pressure paresthesia occurring during LESI as a prognostic factor in determining the efficacy of LESI. Study Design: Prospective, randomized, blinded study. Setting: Pain management center, part of a teaching-community hospital in a major metropolitan US city. Methods: After Institutional Review Board approval, 106 patients undergoing LESI for radicular low back pain were randomly assigned to one of 2 groups (53 patients each) based on approach: midline interlaminar (MIL) and lateral parasagittal interlaminar (PIL). Patients were asked to grade any pressure paresthesia as occurring ipsilaterally or contralaterally to their “usual and customary pain,” or in a distribution atypical of their daily pain. Other variables such as: the Oswestry Disability Index questionnaire, pain scores at rest and during movement, use of pain medications, etc. were recorded 20 minutes before the procedure, and on days 1, 7, 14, 21, 28, 60, 120, 180 and 365 after the injection. Results: Results of this study showed statistically and clinically significant pain relief in patients undergoing LESI by both the MIL and PIL approaches. Patients receiving LESI using the lateral parasagittal approach had statistically and clinically longer pain relief then patients receiving LESI via a midline approach. They also had slightly better quality of life scores and improvement in everyday functionality; they also used less pain medications than patients receiving LESI using a midline approach. Furthermore, patients in the PIL group described significantly higher rates of concordant moderate-to-severe pressure paresthesia in the distributions of their “usual and customary pain” compared to the MIL group. In addition, patients who had concordant pressure paresthesia and no discordant pressure paresthesia (i.e., “opposite side or atypical”) during interventional treatment had better and longer pain relief after LESI. Two patients from each group required discectomy surgery in the one-year observation period. Limitations: The major limitation of this study is that we did not include a transforaminal epidural steroid injection group, since that is one of the approaches still commonly used in contemporary pain practices for the treatment of low back pain with unilateral radicular pain. Conclusions: This study showed that the lateral parasagittal interlaminar approach was more effective than the midline interlaminar approach in targeting low back pain with unilateral radicular pain secondary to degenerative lumbar disc disease. It also showed that pressure paresthesia occurring ipsilaterally during an LESI correlates with pain relief and may therefore be used as a prognostic factor. Key words: lumbar epidural steroid injection, interlaminar injection, low back pain, unilateral radicular pain, midline interlaminar approach, lateral parasagittal interlaminar approach, pressure paresthesia, quality of life, everyday functionality

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Kashlan, Osama Nezar, Hyeun Sung Kim, Siri Sahib S. Khalsa, Singh Ravindra, Zhang Yong, Seong Woon Oh, Jeong Hoon Noh, Il-Tae Jang, and Seong-Hoon Oh. "Percutaneous Endoscopic Contralateral Lumbar Foraminal Decompression via an Interlaminar Approach: 2-Dimensional Operative Video." Operative Neurosurgery, June 24, 2019. http://dx.doi.org/10.1093/ons/opz162.

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Kim, Hyeun Sung, Ji Yeon Kim, Dong Chan Lee, Jun Hyung Lee, and Il-Tae Jang. "A Novel Technique of the Full Endoscopic Interlaminar Contralateral Approach for Symptomatic Extraforaminal Juxtafacet Cysts." Journal of Minimally Invasive Spine Surgery and Technique, March 7, 2022. http://dx.doi.org/10.21182/jmisst.2022.00010.

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Jesse, Christopher Marvin, Andreas Raabe, and Christian T. Ulrich. "The Contralateral Approach to intra- and Extraforaminal Lumbar Disk Herniations: Surgical Technique and Review of Surgical Procedures." Journal of Neurological Surgery Part A: Central European Neurosurgery, December 12, 2021. http://dx.doi.org/10.1055/s-0041-1739221.

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Abstract Background Surgery for intra-/extraforaminal disk herniations (IEDH) is technically demanding due to the hidden location of the compressed nerve root section. Ipsilateral approaches (medial and lateral) are accompanied by extended resection of the facet joint and inadequate visualization of the pathology, especially at the L5–S1 level. Methods We describe a microsurgical interlaminar contralateral approach (MICA) suitable for IEDH at the lumbosacral junction that can also be used at L4–L5 and L3–L4. Conclusion The MICA provides access and sufficient intraforaminal visualization for IEDH in the lumbosacral region without resection of stability-relevant structures or manipulation of the nerve root ganglion.

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Di Rita, Andrea, Vincenzo Levi, Giulia L. Gribaudi, Giuseppe Casaceli, Giovanni Di Leo, Luigi V. Berra, and Marcello Egidi. "The interlaminar contralateral approach to far-lateral lumbar disc herniations: a singlecenter comparison with traditional techniques and literature review." Journal of Neurosurgical Sciences, January 2021. http://dx.doi.org/10.23736/s0390-5616.20.05135-8.

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Gagliardi, Filippo, Edoardo Pompeo, Silvia Snider, Francesca Roncelli, Marzia Medone, Pierfrancesco De Domenico, Martina Piloni, and Pietro Mortini. "COMPARATIVE ANALYSIS ON SURGICAL OPERABILITY AND DEGREE OF EXPOSURE OF MICROSURGICAL APPROACHES TO INTRAFORAMINAL LUMBAR DISC HERNIATIONS." Journal of Neurological Surgery Part A: Central European Neurosurgery, December 8, 2022. http://dx.doi.org/10.1055/a-1994-8142.

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IFDHs (intraforaminal disc herniations) represent a heterogeneous and relatively uncommon disease; their treatment is technically demanding due to the anatomic relationships with nerve roots and vertebral joints. Over time, several approaches have been developed without reaching a consensus about the best treatment strategy. Authors comparatively analyze surgical operability and exposure in terms of quantitative variables between the different microsurgical approaches to intraforaminal lumbar disc herniations (IFDH), defining the impact of each approach on surgical maneuverability and exposure on specific targets. A comparative microanatomical laboratory investigation was conducted. The operability score (OS) was applied for quantitative analysis of surgical operability. Trans-articular and combined translaminar-trans-pars-interarticularis approaches result in providing the best surgical exposure and maneuverability on all targets with surgical controls on both nerve roots, at the expense of a higher risk of iatrogenic instability. Trans-pars-interarticularis approach reaches comparable levels of operability, even limited to the pure foraminal area (lateral compartment); similar findings were recorded for partial facetectomy on the medial compartment. The contralateral interlaminar approach provides good visualization of the foramen without consensual favorable maneuverability, which should be considered as the main drawback. Approach selection has to consider disease location, the possible migration of disc fragments, the degree of nerve root involvement, and risk of iatrogenic instability. According to the findings, authors propose an operative algorithm to tailor the surgical strategy, based both on the precise definition of anatomic boundaries of exposure of each approach, as well as surgical maneuverability on specific targets.

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Kirnaz, Sertac, Gary Kocharian, Fabian Sommer, Lynn B. McGrath, Jacob L. Goldberg, and Roger Härtl. "Ten-Step Minimally Invasive Treatment of Lumbar Giant Disc Herniation via Unilateral Tubular Laminotomy for Bilateral Decompression: 2-Dimensional Operative Video." Operative Neurosurgery, August 19, 2021. http://dx.doi.org/10.1093/ons/opab289.

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Abstract Giant disc herniation (GDH) is generally defined as a lumbar disc herniation that obstructs 50% or more of the space in the spinal canal.1-3 Common treatment options for GDH include unilateral interlaminar approach, bilateral approach, or open full laminectomy.4,5 Surgical treatment of GDH may be challenging because severe bilateral compression of neural elements in the spinal canal increases the risk of iatrogenic injury to nerve roots and dura. The surgical approach can be further complicated by calcification, hardening, and dehydration of the GDH tissue. The prevailing opinion in the literature is that giant disc herniations cannot safely be treated via tubular minimally invasive approaches.5-7 In this video, we present a case of a 52-yr-old male patient with a history of progressive low back pain that radiates bilaterally from the buttocks toward the posterior legs and knees for 2 yr because of a GDH at the L4-5 level. The patient was treated via a tubular “over-the-top” minimally invasive decompression in order to first provide generous bilateral decompression of neural elements and dura.8,9 After sufficient decompression at the surgical level, the discectomy was performed via an ipsilateral piecemeal resection of the GDH. The “over-the-top” contralateral mobilization of disc herniation was also achieved with this approach, which facilitated the removal of the entire disc fragment. Patient consent was obtained prior to performing the procedure. Therefore, GDH should not be considered as a contraindication for tubular decompression when this modified technique is performed.

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Kim, Doo-Hwan, Jin-Woo Shin, and Seong-Soo Choi. "Percutaneous epidural balloon neuroplasty: a narrative review of current evidence." Anesthesia and Pain Medicine, October 26, 2022. http://dx.doi.org/10.17085/apm.22237.

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Percutaneous epidural balloon neuroplasty (PEBN) using a balloon-inflatable catheter can be used to perform balloon decompression combined with percutaneous epidural neuroplasty (PEN), leading to significant pain relief and functional improvement in patients with spinal stenosis. Several prospective and retrospective studies have demonstrated the effectiveness of PEBN and supported its relatively long-term outcomes (at least 6 months, sustained for up to 12 months). Balloon neuroplasty appears to be superior to conventional PEN. Moreover, it has been shown to be effective in patients unresponsive to conventional PEN or in those with post lumbar surgery syndrome. In addition, balloon neuroplasty achieved successful outcomes regardless of the approach used, such as retrodiscal, transforaminal, contralateral interlaminar, or caudal. Chronic radicular pain without lower back pain, neurogenic intermittent claudication, and minimal neuropathic component were predictive factors for favorable outcomes after PEBN from a symptomatic perspective. A short duration of pain after lumbar surgery, lumbar foraminal stenosis caused primarily by degenerative disc herniation, mild foraminal stenosis, and perineural adhesion by degenerative discs were associated with successful outcomes of PEBN from pathological aspects. Ballooning ≥ 50% of the target sites and complete contrast medium dispersion after ballooning seemed to be crucial for successful outcomes from a technical perspective. In addition, PEBN was effective regardless of the accompanying redundant nerve roots or a mild degree of spondylolisthesis. Studies on balloon neuroplasty have reported occasional minor and self-limiting complications; however, no PEBN-related significant complications have been reported. Given the present evidence, balloon neuroplasty appears to be a safe and effective procedure with minimal complications for the treatment of spinal stenosis.

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Journal articles on the topic 'Interlaminar contralateral approach'

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