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Lateral transmuscular or combined interlaminar/paraisthmic approach to lateral lumbar disc herniation? A comparative clinical series of 48 patients
  1. Y M Ryang,
  2. I Rohde,
  3. A Ince,
  4. M F Oertel,
  5. J M Gilsbach,
  6. V Rohde
  1. Department of Neurosurgery, Aachen University (RWTH), Germany
  1. Correspondence to:
 Yu-Mi Ryang
 Department of Neurosurgery, Technical University Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany;


Background: The optimum operative technique for lateral lumbar disc herniations (LLDH) remains unclear, and both interlaminar and extraspinal approaches are used.

Objective: To compare outcome after LLDH removal either by a lateral transmuscular approach (LTM) or by a combined interlaminar and paraisthmic approach (CIP).

Methods: 28 patients underwent surgery using CIP and 20 using LTM. All patients were operated on by the same neurosurgeon. The clinical presentation of the two groups was comparable. Overall outcome was assessed after a mean follow up period of between 19 and 37 months using the Ebeling classification. In addition, the effect of surgery on radicular pain, low back pain, and sensory and motor deficits was defined.

Results: Excellent to good results were achieved in 95% of the LTM group and 57% of the CIP group. The outcome was satisfactory to poor in 5% of the LTM and 43% of the CIP group (p<0.004). The percentage of sensorimotor deficit and of radicular pain improvement was higher in the LTM group. New low back pain was found exclusively in the CIP group (21%). The complication rate was 5% in the LTM group and 11% in the CIP group.

Conclusions: The LTM approach achieves a better overall outcome and improvement in radiculopathy. The complication rate is lower with the transmuscular route and the risk of new low back pain is minimised. These results are likely to be attributable at least in part to the lesser invasiveness of the LTM approach.

  • CIP, combined interlaminar and paraisthmic (approach)
  • LLDH, lateral lumbar disc herniation
  • LTM, lateral transmuscular (approach)
  • lateral disc herniation
  • lumbar disc
  • surgical management

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  • Competing interests: none declared