Minimally invasive contralateral over the top approach for lumbar calcified foraminal lesions: a technical note.

Abstract

OBJECTIVE\nVarious surgical techniques have been described to address intra/extraforaminal lumbar lesions. They vary from the classic posterior open approaches, to minimally invasive techniques with tubular retractors, and even endoscopy. These lesions have been approached from either an ipsi or even a contralateral approach. Only a few reports describe a contralateral minimally invasive tubular approach to address these intra/extraforaminal lesions. However, none of them have been able to address calcified pathologies.\n\n\nMETHOD\nWe used a contralateral tubular approach to remove the calcified disc herniations. Here, we report two patients presenting with radiculopathy due to a calcified intraforaminal L5-S1 disc herniation.\n\n\nRESULTS\nEarly clinical and radiological outcomes were positive. No peri-operative complication occurred.\n\n\nCONCLUSION\nTo our knowledge, this is the first report of the expanded use of fixed tubular retractors to tackle calcified lumbar intraforaminal disc herniations. This approach allows a satisfying access and view of the contralateral foramen and offending lesion. It permits a wide decompression while preserving the facet joint and thus an iatrogenic instability. It can also free oneself from iliac crest which does not allow an ipsilateral extraforaminal approach at L5-S1 level. Such approach is a safe and effective to treat this specific pathology.