Extreme-lateral, minimally invasive, transpsoas approach for the treatment of far-lateral lumbar disc herniation

Report of 2 cases

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The authors present 2 cases of far-lateral lumbar disc herniations treated surgically via an extreme-lateral transpsoas approach. The procedure was performed using the MaXcess minimally invasive retractor system to access and successfully remove the disc fragments without complication. To the authors' knowledge, these are the first reported cases of using a minimally invasive retroperitoneal approach for the treatment of far-lateral disc herniations.

Abbreviation used in this paper: EMG = electromyography.

Article Information

Address correspondence to: Adam S. Kanter, M.D., Department of Neurological Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian, 200 Lothrop Street, Suite B-400, Pittsburgh, Pennsylvania 15213. email: kanteras@upmc.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Magnetic resonance images showing the far-lateral disc herniations in each case. A: Axial image of the patient in Case 1 demonstrating the herniation at L2–3 (arrow) with impingement of the exiting L-2 nerve root. B: Sagittal image of the patient in Case 1 demonstrating narrowing of the L2–3 foramen (arrow) due to disc herniation. C: Axial image of the patient in Case 2 demonstrating the herniation at L3–4 (arrow) with impingement of the exiting L-3 nerve root.

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    Intraoperative images of the extreme-lateral, minimally invasive, transpsoas approach for the treatment of far-lateral disc herniation. A: Setup of the operating table. Note that the table is flexed in such a way as to maximize rib-to-pelvis distance. B: Typical incision size. C: Fluoroscopic image demonstrating the position of the MaXcess retractor after sequential dilation.

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    Case 1. Intraoperative photographs demonstrating the large disc fragment at the L2–3 level before (left) and after (right) its complete removal. D = disc material; DS = disc space; I = inferior; P = posterior; S = superior.

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