Haines Colin M, Samtani Rahul G, Bernatz James T, Abugideiri Mustafa, O'Brien Joseph R
Orthopaedics, Virginia Spine Institute, Reston, USA.
Orthopaedics, University of Wisconsin Hospital and Clinics, Madison, USA.
Cureus. 2018 Oct 2;10(10):e3404. doi: 10.7759/cureus.3404.
Symptomatic far-lateral lumbar disc herniation is a less common causes of lumbar radiculopathy than paracentral or central disc herniation. Treatment of far-lateral disc herniation with a retroperitoneal, transpsoas approach and disc fragment excision has been described. However, treatment of far-lateral disc herniation using lateral lumbar interbody fusion (LLIF) without neural manipulation has not been described. We report one case in which symptom resolution was accomplished via indirect decompression with anterior column support via LLIF without disc fragment excision and review the current literature. The patient noted immediate relief of his preoperative leg pain in the recovery room and ambulation began the same day. Narcotics were effective in treating his incisional pain and mild back pain. The patient was seen two weeks postoperatively and he had stopped all narcotics. At six weeks, the patient continued to have significant improvement and was able to take hour-long walks. At five months, the patient did not have any pain and continued to have improvement in his left quadriceps strength. Minimally invasive lateral lumbar interbody fusion has allowed surgeons to provide both direct and indirect neural decompression through a retroperitoneal approach. This technique may be ideal for far-lateral disc herniation as it also allows a lateral visualization of the herniation without bony, posterior muscular, or ligamentous disruption.
与中央型或旁中央型椎间盘突出症相比，症状性极外侧腰椎间盘突出症是腰椎神经根病较不常见的病因。经腹膜后、经腰大肌入路并切除椎间盘碎片治疗极外侧椎间盘突出症已有相关描述。然而，尚未有关于使用外侧腰椎椎间融合术（LLIF）且不进行神经操作治疗极外侧椎间盘突出症的报道。我们报告了1例通过LLIF在前柱支撑下进行间接减压而不切除椎间盘碎片实现症状缓解的病例，并对当前文献进行综述。患者在恢复室中即感到术前腿痛立即缓解，且于同日开始行走。镇痛药有效缓解了其切口疼痛和轻度背痛。术后两周对患者进行检查时，他已停用所有镇痛药。六周时，患者持续显著改善，能够进行长达1小时的步行。五个月时，患者已无疼痛，且左股四头肌力量持续改善。微创外侧腰椎椎间融合术使外科医生能够通过腹膜后入路进行直接和间接神经减压。该技术可能是治疗极外侧椎间盘突出症的理想方法，因为它还能在不破坏骨质、后方肌肉或韧带的情况下从外侧观察到突出情况。
