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Anatomic investigation of lumbar transforaminal fenestration approach and its clinical application in far lateral disc herniation.

Abstract Treating lumbar disease at the intervertebal foramina is controversial because we lack an approach providing sufficient exposure and preserving spinal stability. The primary objective of this study was to investigate the feasibility of the transforaminal fenestration (TFF) approach for treating lumbar disease involving the intervertebal foramina.In the anatomic study of 30 adult cadaveric lumbar spine specimens, the TFF approach was used from L1 to S1. The scope of resection was measured manually and on 3D CT images. 3D CT images of the lumbar spine of 31 adult patients were collected, and the scope of resection needed during the TFF approach was defined and measured from L1 to S1. In total, 30 patients (14 men) with lumbar FLDH underwent microendoscopic discectomy (MED) via the TFF approach. The results were evaluated with visual analog scale (VAS), Oswestry Disability Index (ODI), Short Form-36 survey (SF-36), and the MacNab scale.In cadavers, the TFF approach provided sufficient exposure to the posterolateral aspect of the disc and the exiting nerve root at all segments. At L1 to L4, a relatively small part of the isthmus and facet joint was resected; at L4 to S1, a relatively large part of the isthmus and facet joint was resected, so luniform fenestration was needed to preserve a more inferior articular process and continuity of the isthmus. Treatment with MED via the TFF approach was successful in the 30 patients with significantly relieved of symptom after operation. In total, 24 patients were followed for a mean of 24 months. The VAS, ODI, SF-36 physical component, and mental component summary scores at the final follow-up improved significantly compared with preoperative data (Pā€Š<ā€Š.05), and excellent results were obtained in 19 patients and good results in 6 according to the Macnab scale.The TFF approach can provide sufficient exposure to the lumbar intervertebal foramina with preservation of stability and can be used effectively with MED to treat lumbar FLDH.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28723772
OWN - NLM
STAT- MEDLINE
DA  - 20170720
DCOM- 20170728
LR  - 20170801
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 29
DP  - 2017 Jul
TI  - Anatomic investigation of lumbar transforaminal fenestration approach and its
      clinical application in far lateral disc herniation.
PG  - e7542
LID - 10.1097/MD.0000000000007542 [doi]
AB  - Treating lumbar disease at the intervertebal foramina is controversial because we
      lack an approach providing sufficient exposure and preserving spinal stability.
      The primary objective of this study was to investigate the feasibility of the
      transforaminal fenestration (TFF) approach for treating lumbar disease involving 
      the intervertebal foramina.In the anatomic study of 30 adult cadaveric lumbar
      spine specimens, the TFF approach was used from L1 to S1. The scope of resection 
      was measured manually and on 3D CT images. 3D CT images of the lumbar spine of 31
      adult patients were collected, and the scope of resection needed during the TFF
      approach was defined and measured from L1 to S1. In total, 30 patients (14 men)
      with lumbar FLDH underwent microendoscopic discectomy (MED) via the TFF approach.
      The results were evaluated with visual analog scale (VAS), Oswestry Disability
      Index (ODI), Short Form-36 survey (SF-36), and the MacNab scale.In cadavers, the 
      TFF approach provided sufficient exposure to the posterolateral aspect of the
      disc and the exiting nerve root at all segments. At L1 to L4, a relatively small 
      part of the isthmus and facet joint was resected; at L4 to S1, a relatively large
      part of the isthmus and facet joint was resected, so luniform fenestration was
      needed to preserve a more inferior articular process and continuity of the
      isthmus. Treatment with MED via the TFF approach was successful in the 30
      patients with significantly relieved of symptom after operation. In total, 24
      patients were followed for a mean of 24 months. The VAS, ODI, SF-36 physical
      component, and mental component summary scores at the final follow-up improved
      significantly compared with preoperative data (P &lt; .05), and excellent results
      were obtained in 19 patients and good results in 6 according to the Macnab
      scale.The TFF approach can provide sufficient exposure to the lumbar
      intervertebal foramina with preservation of stability and can be used effectively
      with MED to treat lumbar FLDH.
FAU - Xu, Baoshan
AU  - Xu B
AD  - aDepartment of Minimally Invasive Spine Surgery, Tianjin Hospital, Hexi District,
      Tianjin, People's Republic of China bService de Neurochirurgie, Hopital
      Bagatelle, Talence, France.
FAU - Xu, Haiwei
AU  - Xu H
FAU - Destandau, Jean
AU  - Destandau J
FAU - Ma, Xinlong
AU  - Ma X
FAU - He, Jian
AU  - He J
FAU - Xia, Qun
AU  - Xia Q
FAU - Ji, Ning
AU  - Ji N
FAU - Yang, Qiang
AU  - Yang Q
FAU - Liu, Yue
AU  - Liu Y
FAU - Jiang, Hongfeng
AU  - Jiang H
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cadaver
MH  - Diskectomy/*methods
MH  - Endoscopy/methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Imaging, Three-Dimensional
MH  - Intervertebral Disc Displacement/diagnostic imaging/pathology/*surgery
MH  - Lumbar Vertebrae/diagnostic imaging/pathology/*surgery
MH  - Male
MH  - Microsurgery/*methods
MH  - Middle Aged
MH  - Pain/diagnostic imaging/pathology/surgery
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
PMC - PMC5521912
EDAT- 2017/07/21 06:00
MHDA- 2017/07/29 06:00
CRDT- 2017/07/21 06:00
AID - 10.1097/MD.0000000000007542 [doi]
AID - 00005792-201707210-00037 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Jul;96(29):e7542. doi: 10.1097/MD.0000000000007542.