Paramuscular approach [Neurosurgery Wiki]

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=====Paramuscular approach=====
Approach for [[Extreme lateral lumbar disc herniation]].

The paramuscular approach requires a larger incision and greater soft-tissue retraction, but exposes less of the foramen;
((Fankhauser H, de Tribolet N. Extreme lateral lumbar disc herniation. Br J Neurosurg 1987;1:111-29.))
its advocates find the muscle-splitting approach disorientating because of the lack of anatomical landmarks
((Siebner HR, Faulhauer K. Frequency and specific surgical management of far lateral lumbar disc herniations. Acta Neurochir Wien 1990;105:124-31.))
((Hood RS. Far lateral lumbar disc herniations. Neurosurg Clin N Am 1993;4:117-24.)).

The target of the surgical exposure is the isthmus. Good knowledge of the anatomic features of the intervertebral foramen and intertransverse space is mandatory
((Tessitore E, de Tribolet N. Far-lateral lumbar disc herniation: the
microsurgical transmuscular approach. Neurosurgery. 2004 Apr;54(4):939-42;
discussion 942. PubMed PMID: 15046661.
)).