Journal de la colonne vertébrale

A Minimally Invasive Approach to the Lumbar Neural Foramen and Extraforaminal Compartment: Modified Surgical Technique

Abstract

Michael S. Virk and Eric Elowitz

Surgical approaches to the neural foramen and the lateral extraforaminal space in the lumbar spine are required to treat far lateral disc herniations and shwannomas. The MetRx tubular retractor system facilitates a minimally invasive technique that directly targets the region delineated by Kambin’s triangle. This study presents technical modifications, described in a step-wise fashion, to previously published approaches.

We reviewed the charts of 47 patients that underwent surgery for pathology located in Kambin’s Triangle using the modified technique described here. Important technical adjustments include docking on the pars interarticularis, minimal shaving of the lateral pars and inferior articulating process, and palpation of the pedicle as a reference point for opening the ligamentumflavum and locating the exiting nerve. Potential pitfalls and strategies to avoid them are also noted.

All 47 patients reported a successful outcome with the procedure, there were no complications or revisions, and all were discharged home within 24 hours of the procedure. Key elements of the procedure were highlighted with supporting illustrations and intra-operative imaging.

The minimally-invasive approach performed through MetRx tubular retractors is a safe and successful surgical method for treating pathology localized in the neural foramen and lateral extraforaminal space between L1- L5 vertebrae.