Minimally invasive tubular approach for lumbar extraforaminal disc herniation: how I do it.

Abstract

Minimally invasive surgical resection of extraforaminal disc herniation is challenging. The anatomical landmarks are varying from common interlaminar approach. The main risk is to damage the exiting nerve root as it is not yet protected by any bony structure. Here, we present the different steps of the minimally invasive approach to resect a lumbar extraforaminal disc herniation, using tubular retractor under microscopy. Once the key steps of tubular placements are well known, minimally invasive approach for such extraforaminal resection affords appropriate exposure, while reducing blood loss and muscle injury.