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  • The Minimally Invasive Paramedian Approach for Foraminal Disc Herniation

    Final Number:

    Terence Verla MD MPH; Eric A Goethe BS; Visish M. Srinivasan MD; Ibrahim Omeis MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Foraminal disc herniation (FDH) accounts for up to 12% of lumbar herniated discs. The disc fragment presents a challenge as it often resides lateral to the pedicle and posterior to the facet joints, forcing some surgeons to violate the facet joint which disrupts spinal stability. Herein, we describe a series of patients that underwent minimally invasive paramedian approach with hemilaminectomy, partial medial pars resection, medial facetectomy for foraminal disc herniation.

    Methods: We retrospectively reviewed 21 cases of patients with FDH who underwent a minimally-invasive paramedian microdiscectomy. Demographic and clinical varaibles were obtained from medical records. Improvement in functional outcomes was evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI).

    Results: A total of 21 patients were included in this study .The average age was 56.47+/-9.4yrs and body mass index was 31.92 +/- 7.7Kg/m2. 47.8% of cases were L4-5 FDH. Average duration of symptoms was 7.58 +/- 10.1months. The estimated blood loss was 31.32 +/- 19.8 ml. The average length of hospital stay was 1.11 +/- 0.3days. All patients were discharged home. Follow up duration was about 5.22 +/- 4.7 months. Overall, there was a significant improvement in the VAS (pre-op: 8.21 +/- 2.1; post-op: 2.59 +/- 2.7; p-value: <0.0001) and ODI (pre-op: 57.16 +/- 13.2; post-op: 21.47 +/- 9.9; p-value: <0.0001) post-operatively. Only one patient required revision fusion for asymmetric collapsed disc height and severe foraminal stenosis.

    Conclusions: The minimally invasive paramedian approach provides satisfactory outcomes as a safe strategy in the treatment of foraminal disc herniation. Herein, there was a significant improvement in pain and functional outcomes, minimal blood loss and decreased hospital stay.

    Patient Care: Patient will benefit from a minimally invasive procedure, less complications, shorter length of stay, significant improvement in pain and functional disability.

    Learning Objectives: The minimally invasive paramedian approach is safe for far lateral foraminal disc herniation Significant reduction in pain and improvement in functional outcomes


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