Analysis of the efficacy of microchannel surgery for far lateral lumbar disc herniation via the Wiltse intermuscular approach
Objective To explore the surgical technique and clinical efficacy of microchannel surgery via the Wiltse intermuscular approach for the treatment of far lateral lumbar disc herniation(FL L DH).Methods We retrospectively analyzed the clinical data of 7 cases of FLLDH(intervertebral foraminal type Ⅲ)admitted to the Department of Neurosurgery,the First Affiliated Hospital of Shandong First Medical University(Shandong Provincial Qianfoshan Hospital)from September 2021 to June 2023.All those patients had severe pain in the lumbar back and numbness and hypesthesia in the affected lower limbs before surgery.The locations of surgical access and microchannels were determined according to preoperative lumbar CT and MRI scans.The herniated disc was microsurgically resected in the microchannel through the Wiltse intermuscular approach.The patients were followed up by telephone or outpatient clinic at 2 weeks,1,3,6 months and 1 year after surgery.The degree of postoperative pain relief and the presence or absence of new-onset low back pain were assessed based on the visual analogue scale(VAS).The stability of the spine and damage of the small joints were assessed based on lumbar spine CT and three-dimensional reconstruction.The clinical outcomes were evaluated based on the modified MacNab criteria.Results Surgeries were all successfully completed in 7 patients,with an operation duration of 62±9 min and intraoperative bleeding volume of 15.0(12.5,20.0)ml.The severe pain in the low back and the numbness and hypoesthesia symptoms in the affected lower limbs of the 7 patients improved significantly after operation.The VAS score was 2.1±0.9 at 2 weeks post operation,which significantly improved compared with preoperative(7.3±1.0,paired t=6.79,P＜0.001).The lumbar spine CT and three-dimensional reconstruction at 1 month post operation indicated good protection of the small joints and articular eminences,with little damage to the vertebral plate.No lumbar spine instability or deformity was found.The outcomes of 6 patients assessed based on the modified MacNab criteria were excellent in 5 cases and good in 1 case at 6 months post operation.The median follow-up period of the patients was 13 months(3-24 months).By the latest follow-up,all patients had no recurrence of low back pain,lumbar instability or nerve root injury.Conclusions Microchannel surgery via the Wiltse intermuscular approach is safe and effective in the treatment of FLLDH.It is associated with good clinical outcomes based on short-to medium-term follow-up.
Intervertebral disc displacementDiskectomyExtreme lateral lumbar disc herniationMicrochannelWiltse intermuscular space
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