Extreme lateral and interlaminar approach for intra-canal and foraminal double disc herniation at lumbosacral level

Abstract

Introduction and objectives: There are several approaches for double disc herniation consisting of an intracanal and foraminal lesion. Of several approaches, we introduced extreme lateral and interlaminar approach (ELIA). And we aimed to compare the approach with the conventional combined interlaminar and paraisthmic approach (CIPA).

Patients and methods: The authors reviewed the medical charts of patients who underwent a procedure for a double disc herniation at the lumbosacral level between March 2012 and February 2016 and patients who underwent CIPA or ELIA were selected. For preoperative testing, simple X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) scans were performed. For postoperative outcomes, the Korean version of the Oswestry Disability Index (K-ODI) and Numeric Rating Scale (NRS) at one, two, and three months post-operation were checked.

Results: Eleven patients were given ELIA and twenty-four patients were involved in CIPA. The mean pre K-ODI was 34.1 (±13.9) and 32.4 (±4.0) at each group. 1st, 2nd and 3rd month post-operative K-ODI was 8.2 (±4.1), 6.4 (±2.1) and 5.3 (±2.4) in ELIA and 8.1 (±3.2), 7.1 (±3.5) and 8.4 (±6.4) in CIPA. Post-operative 3rd month K-ODI showed significant difference between two groups (p: 0.005). The mean pre NRS was 8 (±0.9) and 8.6 (±1.0). 1st, 2nd and 3rd month post-operative NRS was 2.4 (±1.5), 2.2 (±1.5) and 2.0 (±0.9) in ELIA and 3.3 (±1.4), 3.3 (±1.6) and 3.7 (±1.9). Post-operative 3rd month NRS showed significant difference between two groups as well (p: 0.001). There were four (19.0%) recurrence cases in CIPA patients group, otherwise there was no recurrence case in ELIA group.

Conclusions: In the treatment of L5-S1 double disc herniation, the ELIA surgical approach showed better outcomes than the CIPA surgical approach did with respect to pain and K-ODI during a mid-term follow-up examination conducted three months post-operation.

Keywords: Abordaje combinado; Combined approach; Disc herniation; Hernia discal; Lumbar; Lumbosacral junction; Unión lumbosacra.