Intertransverse approach for extraforaminal herniations

Study Design. This case report illustrates three patients with extraforaminal disc herniation in the lumbar spine. Objectives. Treatment consisted of discectomy through an intertransverse approach. Summary of Background Data. The surgical treatment of lumbar disc herniation bas been well studied and reported in the literature. Laminectomy, foraminotomy, and facetectomy have traditionally been used for extraforaminal disc herniation. Intertransverse discectomy used in these three patients confirms the benefits of this approach. Surgical Method. A midline incision was made, and the paraspinous muscles on the affected side were detached to expose the appropriate laminae, facets, transverse processes, and intertransverse ligament. After resecting the ligament and retracting the compressed spinal nerve outside the facet, the nucleus pulposus was removed. Results. Postoperative results were satisfactory. Weakness and low back and leg pain disappeared rapidly. The three patients returned to work 2-3 months postoperatively. Conclusions. The patho-anatomical characteristic of the entity is compression of the spinal nerve outside the foramen. Intertransverse discectomy is a rational technique-its advantages are that the spinal canal is not opened, spine stability is maintained, and multiple disc herniation can be managed through a single posterior midline incision.