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

Stavrinou P, Härtl R, Krischek B, Kabbasch C, Mpotsaris A, Goldbrunner R - Biomed Res Int (2016)

Bottom Line: 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.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, 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.

No MeSH data available.


Related in: MedlinePlus

(a) Mean NRS preoperatively, postoperatively, and on follow-up. (b) Mean ODI-D preoperatively and on follow-up. Error bars show 95% CI.
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fig3: (a) Mean NRS preoperatively, postoperatively, and on follow-up. (b) Mean ODI-D preoperatively and on follow-up. Error bars show 95% CI.

Mentions: Mean operation time was 130.5 minutes (range 98–217 minutes) with no significant difference between herniated disc and foraminal stenosis cases (Mdh = 137.8 versus Mfs = 119.5 min), and mean blood loss was 77 mL (range 50–150 mL). In only one patient with a disc protrusion was drilling of the lateral facet necessary; however, all foraminal stenosis cases required drilling of the facet joint and the caudal surface of the L5 transverse process. Conservative discectomy was performed in all cases. There were no intraoperative complications. One patient (patient number 4, Table 1) developed an early disc herniation recurrence which required a revision surgery, and another had dysesthesia along the L5 dermatome that resolved after three months. Mean hospital stay was five days. All patients reported significant relief of their preoperative pain. NRS at discharge averaged at 2.1. The patients were followed up for a mean of 22 (8–38) months. All patients that had a preoperative motor deficit improved at least one grade on the muscle strength scale, while the sensory deficits resolved in all cases but one, in which a mild hypoesthesia persisted (Table 1). NRS on follow-up remained low (M = 1.9). Pain postoperatively, both directly after the operation and on follow-up, was significantly improved compared to preoperatively (F(2,18) = 115, p < 0.001) (Figure 3(a)). There was also a significant improvement of the ODI score at the final follow-up compared to preoperative scoring (M = 11, F(1.9) = 142.4, p < 0.001) (Figure 3(b)). General clinical outcome based on the Macnab scale was excellent in three (30%) patients, good in five (50%), and fair in two (20%). Nine out of ten patients returned to their jobs or resumed their preoperative activities.


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

Stavrinou P, Härtl R, Krischek B, Kabbasch C, Mpotsaris A, Goldbrunner R - Biomed Res Int (2016)

(a) Mean NRS preoperatively, postoperatively, and on follow-up. (b) Mean ODI-D preoperatively and on follow-up. Error bars show 95% CI.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834392&req=5

fig3: (a) Mean NRS preoperatively, postoperatively, and on follow-up. (b) Mean ODI-D preoperatively and on follow-up. Error bars show 95% CI.
Mentions: Mean operation time was 130.5 minutes (range 98–217 minutes) with no significant difference between herniated disc and foraminal stenosis cases (Mdh = 137.8 versus Mfs = 119.5 min), and mean blood loss was 77 mL (range 50–150 mL). In only one patient with a disc protrusion was drilling of the lateral facet necessary; however, all foraminal stenosis cases required drilling of the facet joint and the caudal surface of the L5 transverse process. Conservative discectomy was performed in all cases. There were no intraoperative complications. One patient (patient number 4, Table 1) developed an early disc herniation recurrence which required a revision surgery, and another had dysesthesia along the L5 dermatome that resolved after three months. Mean hospital stay was five days. All patients reported significant relief of their preoperative pain. NRS at discharge averaged at 2.1. The patients were followed up for a mean of 22 (8–38) months. All patients that had a preoperative motor deficit improved at least one grade on the muscle strength scale, while the sensory deficits resolved in all cases but one, in which a mild hypoesthesia persisted (Table 1). NRS on follow-up remained low (M = 1.9). Pain postoperatively, both directly after the operation and on follow-up, was significantly improved compared to preoperatively (F(2,18) = 115, p < 0.001) (Figure 3(a)). There was also a significant improvement of the ODI score at the final follow-up compared to preoperative scoring (M = 11, F(1.9) = 142.4, p < 0.001) (Figure 3(b)). General clinical outcome based on the Macnab scale was excellent in three (30%) patients, good in five (50%), and fair in two (20%). Nine out of ten patients returned to their jobs or resumed their preoperative activities.

Bottom Line: 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.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, 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.

No MeSH data available.


Related in: MedlinePlus