Microinvasive Bilateral Decompression Via Unilateral Surgical Approaches in The Bilateral Lumbar Disc Herniation (Contralateral Discectomy): A Novel Technique and Clinical Study
Journal Title: Journal of Neurological Sciences-Turkish - Year 2006, Vol 23, Issue 2
Abstract
Objective: Bilateral lumbar disc herniation is rare in the neurosurgical practices. Surgical approach in bilateral lumbar disc herniation is bilateral laminotomy and discectomy. This technique has disadvantages. Minimally invasive bilateral microdecompressive surgery (contralateral discectomy) is described by unilateral laminotomy (MIBMS) technique in this study and not reported before, but minimal invasive microdecompressive spinal canal decompression without contralateral discectomy has been reported in the lumbar spinal stenosis. Contralateral discectomy is a novel technigue. We now describe our clinical experience with this novel technique, minimally invasive bilateral microdiscectomy via unilateral laminotomy technique in the four patients. Methods: We prospectively four patients with lumbar bilateral disc herniation surgically treated with MIBMS. Short-term follow-up was available for 2 patients (7 weeks, 5 month) and long-term follow-up was available for 2 patients (2 year, 2.5 year ). Clinical outcome was determined by chart review and the use of a standardized questionnaire. All of pateints were operated by epidural anasthesia, for thus, preoperative and postoperative back and leg pain, ambulation, employment status, and satisfaction were assessed. Results: All of them were operated by this technique with successfully. No postoperative complications. Overall improvement postoperatively was noted in 94% of the bilateral lumbar disc herniations at mild and long-term follow-up. Average hospital stay day was 1 day, respectively. Visual analog scale (VAS) value was mean 2. Conclusion: We believe that MIBMS better preserves the spine's natural architecture and may contribute to improved postoperative contralateral osseoligamentousmuscle stability. As surgeons push for less radical or less invasive surgical techniques to obtain the same or better postoperative results, MIBMS is a good alternative to total laminectomy or bilateral hemipartially laminectomies. This new techniques was achieved under the midline, thereby preserving the supraspinous-interspinous ligaments and contralateral musculature. This technique is superior in bilateral pathologies.
Authors and Affiliations
Kadir KOTIL, Turgay BILGE
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