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Biomed Res Int. 2016;2016:3487437. doi: 10.1155/2016/3487437. Epub 2016 Apr 4.

Navigated Transtubular Extraforaminal Decompression of the L5 Nerve Root at the Lumbosacral Junction: Clinical Data, Radiographic Features, and Outcome Analysis.

Author information

1
Department of Neurosurgery, University Hospital of Cologne, 50937 Cologne, Germany.
2
Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10021, USA.
3
Department of Radiology and Neuroradiology, University Hospital of Cologne, 50937 Cologne, Germany.

Abstract

PURPOSE:

Extraforaminal decompression of the L5 nerve root remains a challenge due to anatomic constraints, severe level-degeneration, and variable anatomy. The purpose of this study is to introduce the use of navigation for transmuscular transtubular decompression at the L5/S1 level and report on radiological features and clinical outcome.

METHODS:

Ten patients who underwent a navigation-assisted extraforaminal decompression of the L5 nerve root were retrospectively analyzed.

RESULTS:

Six patients had an extraforaminal herniated disc and four had a foraminal stenosis. The distance between the L5 transverse process and the para-articular notch of the sacrum was 12.1 mm in patients with a herniated disc and 8.1 mm in those with a foraminal stenosis. One patient had an early recurrence and another developed dysesthesia that resolved after 3 months. There was a significant improvement from preoperative to postoperative NRS with the results being sustainable at follow-up. ODI was also significantly improved after surgery. According to the Macnab grading scale, excellent or good outcomes were obtained in 8 patients and fair ones in 2.

CONCLUSIONS:

The navigated transmuscular transtubular approach to the lumbosacral junction allows for optimal placement of the retractor and excellent orientation particularly for foraminal stenosis or in cases of complex anatomy.

PMID:
27127783
PMCID:
PMC4834392
DOI:
10.1155/2016/3487437
[Indexed for MEDLINE]
Free PMC Article

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