J Korean Neurosurg Soc.  2013 Oct;54(4):366-369. 10.3340/jkns.2013.54.4.366.

Surgical Tips to Preserve the Facet Joint during Microdiscectomy

Affiliations
  • 1Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea. nskimkt7@gmail.com

Abstract

Lumbar microdiscectomy (MD) is the gold standard for treatment of lumbar disc herniation. Generally, the surgeon attempts to protect the facet joint in hopes of avoiding postoperative pain/instability and secondary degenerative arthropathy. We believe that preserving the facet joint is especially important in young patients, owing to their life expectancy and activity. However, preserving the facet joint is not easy during lumbar MD. We propose several technical tips (superolateral extension of conventional laminotomy, oblique drilling for laminotomy, and additional foraminotomy) for facet joint preservation during lumbar MD.

Keyword

Lumbar disc herniation; Microdiscectomy; Facet joint; Laminotomy; Foraminotomy

MeSH Terms

Foraminotomy
Humans
Laminectomy
Life Expectancy
Zygapophyseal Joint*

Figure

  • Fig. 1 A : Superolateral extension of conventional laminotomy can help in securing the shoulder portion of the traversing nerve root. The added exposure allows for better visualization of the disc space or herniated disc material and usually results in safe discectomy (red fan-shape : superolateral extension of conventional laminotomy, red square : conventional laminotomy, yellow line : traversing nerve root). B : Superolateral extension of conventional laminotomy of postoperative finding (red circle : postoperative finding).

  • Fig. 2 Demonstrating how the facet joint angles were measured relative to the coronal plane, the faect joint angles of this lumbar level are 42°. Oblique drilling for laminotomy should permit proper surgical view without facet joint violation (red square : conventional laminectomy, yellow square : our laminotomy).

  • Fig. 3 A : Additional foraminotomy is helpful to achieve root decompression. It can increase the movability of the affected nerve root; consequently, it should decrease the possibility of retraction injury during discectomy (red fan-shape : additional foraminotomy, red square : laminotomy, yellow line : affected nerve root), B : Additional foraminotomy (red circle : postoperative finding).


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