Navigation-assisted extraforaminal lumbar disc microdiscectomy: Technical note
Giovanni Federico Nicoletti1, Giuseppe Emmanuele Umana2, Bipin Chaurasia3, Giancarlo Ponzo1, Massimiliano Giuffrida1, Giuseppe Vasta1, Santino Ottavio Tomasi4, Francesca Graziano5, Salvatore Cicero2, Gianluca Scalia1
1 Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
2 Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
3 Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
4 Department of Neurological Surgery - Christian Doppler Klinik Paracelsus Medical University; Department of Neurosurgery, Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, Salzburg, Austria
5 Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania; Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP “Paolo Giaccone,” Palermo, Italy
Neurosurgery Unit, Highly Specialized Hospital and of National Importance “Garibaldi” Piazza Santa Maria di Gesu, 5, 95124 Catania
Source of Support: None, Conflict of Interest: None
Background: Extraforaminal lumbar disc herniation (ELDH) amounts of 7%–12% of all lumbar disc herniations. Although they have already been widely described, an optimal treatment is still under discussion in the literature.
Objective: We describe a novel application of navigation using 2D/3D imaging system to plan an adequate surgical trajectory and performing a neuronavigated microdiscectomy in ELDH that has not been previously described.
Methods: This is a retrospective study in a single institution. Between February 2017 and July 2020, a total of 12 patients (7 males and 5 females), with a mean age of 56 years (range 49–71 years), have been treated because of ELDH through a far lateral microdiscectomy using 2D/3D imaging system-assisted neuronavigation (O-arm).
Results: No intraoperative and/or postoperative complications were recorded. Patients presented a mean preoperative Visual Analog Scale (VAS) score of 7.83 ± 0.83 (range 7–9). At the day of discharge, leg pain VAS score effectively improved, decreasing to a mean value of 1.83 ± 0.83 (range 1–3). Further, low back and radicular pain improvement was recorded at 1-, 6-, and 12-month follow-up, respectively.
Conclusion: We described a novel use of 2D/3D imaging system navigation in the microsurgical treatment of ELDH that has not previously reported. This technique is safe and effective and provides more intraoperative details compared to fluoroscopy, which can be crucial for the success of the procedure and to reduce complications and particularly indicated in complex cases with altered anatomy.