Surgical Treatment for Extraforaminal Intervertebral Disc Herniation of the Lumbar Spine.

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This study evaluated the instability of the lumbar spine after osteoplastic hemilaminectomy. Twelve patients with extraforaminal intervertebral disc herniation of the lumbar spine were studied, (these subjects represented 7% of the total number of subjects with lumbar disc herniation). Subjects were 8 males and 4 females with a mean age of 50 years ranging from 20 to 70 years. The duration of follow-up varied from 4 months to 58 months, with a mean of 2 years. 11 patients underwent osteoplastic hemilaminectomy and one patient had an osteoplastic bilaterallaminectomy. Subjects were evaluated radiologically with regard to bone union, range of motion, osteoarthritis of the facet joint and clinical results.The main findings were as follows:1. The results at the time of final follow-up were excellent in 58%, good in 33%.2. The bone union rate at the spinous process was 100%. There was 78% of the osteoplastic laminectomy in bone union at the lamina in osteotomy.3. ROM at the level of the disc herniation decreased about 12% postoperatively.4. 60% of the osteoplastic laminectomy (3 of 5 cases) were due to osteoarthritis of the facet joint.5. There were no cases of instability.These results show that the osteoplastic hemilaminectomy is an excellent surgical technique for patients with extraforaminal intervertebral disc herniation of the lumbar spine.This paper also introduces a new technique for osteoplastic hemilaminectomy using a stainless steel thread wire. This offered the following advantages, compared with an osteotomy using a chisel.1. There is no cracking and no warped bone when performing an osteotomy of the spinous process.2. There is sharp cutting line of the cortex at the side of the canal when performing an osteotomy of the lamina.3. The direction of the cutting is the opposite in osteotomy using the chisel. This means in a direction away from the nerve. Therefore, there is less possibility of nerve root injury.4. There is less cutting loss.

Surgical Treatment for Extraforaminal Intervertebral Disc Herniation of the Lumbar Spine.

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