VERTEBRIS Lumbar-Thoracic - Richard Wolf

Vertebrisproject beyond the middle of the cranialpedicle. At the highest lumbar levels thelaterality of the approach is limited bythe thoracic and abdominal organs.Because of the greater size of the intervertebralforamen cranially and the possibilityof bone resection, a larger radiusof action is achieved here andconsequently a less lateral access routecan be chosen. In the case of intra andextraforaminal decompression operationsthere are no restrictions. Here, too,a lateral approach is attempted in orderto permit atraumatic passage below theexiting spinal root. The surgical accesstechnique for intra- or extraforaminaldisc herniations and foraminal stenosismay differ from the conventional techniquein order to avoid damaging exitingnerve roots that are dislocated or notdefinitely localizable. In such cases theextraforaminal approach is used.Intradiscal procedures such as thoserequired for fusion or infection often callfor the posterolateral approach. The approachis always determined by the targetpoint, account being taken of individualpathology and anatomy. Outsideof the established indications for itsuse, the transforaminal approach hasdefinite limitations.* Ruetten et al. (2005) An extreme lateral accessfor the surgery of lumbar disc herniationsinside the spinal canal using the full-endoscopicuniportal transforaminal approach.– Technique and prospective results of 463patients. Spine 30:2570–2578Ruetten et al. (2007) Use of newly developedinstruments and endoscopes: full-endoscopicresection of lumbar disc herniations via theinterlaminar and lateral transforaminal approach.J Neurosurg Spine 6:521-530The lateral transforaminal approach providesaccess to the spinal canal in the lower lumbarsegmentsIn the lower lumbar segments the pelviscan prevent the required lateral transforaminalaccessThe lateral transforaminal approach shiftsthe working area to the spinal canal7