RESUMEN
BACKGROUND: Far lateral lumbar disc herniations, while infrequent, are a substantial cause of morbidity causing painful radicular syndromes often accompanied by a motor or sensory deficit. Surgical treatment can be challenging technically because of unfamiliar lateral anatomy and the importance of adjacent osseous structures, notably the pars interarticularis and facet joint. METHOD: The traditional approach for a far lateral lumbar disc herniation involves a midline incision, wide lateral subperiosteal exposure and partial removal of these structures with the potential for iatrogenic instability. A paramedian approach to the lateral compartment of the disc space is advantageous because it directly targets the pathology. The use of recently developed minimally invasive retractor systems decreases tissue dissection and blood loss and improves postoperative recovery. RESULTS AND DISCUSSION: We present a series of 20 patients who underwent far lateral discectomy using a minimally invasive muscle splitting approach.
Asunto(s)
Discectomía/métodos , Desplazamiento del Disco Intervertebral/cirugía , Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Espondilosis/cirugía , Adulto , Anciano , Discectomía/instrumentación , Femenino , Humanos , Disco Intervertebral/diagnóstico por imagen , Disco Intervertebral/patología , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/patología , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/patología , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Radiografía , Espondilosis/diagnóstico por imagen , Espondilosis/patologíaRESUMEN
OBJECT: Tarlov or perineurial cysts are lesions of the nerve root most often found in the sacral region. Although there is agreement that asymptomatic Tarlov cysts should be followed, it is still debated whether patients with symptomatic Tarlov cysts should be treated surgically. The authors assessed the outcome and efficacy of cyst wall resection in 10 patients with symptomatic Tarlov cysts. The medical literature is reviewed, theories of origin are evaluated, and suggestions as to their cause and pathogenesis are offered. METHODS: Ten consecutive patients harboring symptomatic Tarlov cysts were treated by the senior author between 1989 and 1999. All patients were assessed for neurological deficits and pain by neurological examination and visual analog scale, respectively. Computerized tomography myelography was performed in all patients to diagnose delayed filling of the cysts. A sacral laminectomy with resection of the sacral cyst or cysts was performed in all patients. Resected material from eight of 10 patients was submitted for histopathological evaluation. Seven (70%) of 10 patients obtained complete or substantial resolution of their symptoms, with an average follow up of 31.7 months. All of these patients had Tarlov cysts larger than 1.5 cm in diameter, producing radicular pain or bladder and bowel dysfunction. Three (30%) of 10 patients experienced no significant improvement. All three patients harbored Tarlov cysts smaller than 1.5 cm in diameter, producing nonradicular pain. Histopathological examination was performed on specimens from eight of 10 patients, which demonstrated nerve fibers in 75% of cases, ganglion cells in 25% of cases, and evidence of old hemorrhage in half. CONCLUSIONS: Large cysts (> 1.5 cm) and the presence of associated radicular symptoms strongly correlate with excellent outcome. Tarlov cysts may result from increased hydrostatic pressure and trauma.