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; 1) its advocates find the muscle-splitting approach disorientating because of the lack of anatomical landmarks 2) 3).
The target of the surgical exposure is the isthmus. Good knowledge of the anatomic features of the intervertebral foramen and intertransverse space is mandatory 4).
1)
Fankhauser H, de Tribolet N. Extreme lateral lumbar disc herniation. Br J Neurosurg 1987;1:111-29.
2)
Siebner HR, Faulhauer K. Frequency and specific surgical management of far lateral lumbar disc herniations. Acta Neurochir Wien 1990;105:124-31.
3)
Hood RS. Far lateral lumbar disc herniations. Neurosurg Clin N Am 1993;4:117-24.
4)
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.