Abstract

Background: The failed back surgery is an important problem in the spinal surgery. Commonly causes are misdiagnosis, inappropriate operation, instability, residual and persistent disc, lateral or central spinal stenosis, epidural fibrosis, infection and neuronal injury. The epidural fibrosis has still occurs even new and less invasive surgical techniques and the rate is over than estimated. Facet joint damages, instability, haematoma, flavectomy, laminectomy, used some biomaterials, cauterization, residual disc and tissue injuries may be triggered epidural fibrosis. Objective: If we can diminish the tissue injury and limited to use some biomaterials (cotton, haemostatic agent) and electrical coagulation, the epidural fibrosis can be minimize. Technique: We describe less invasive microdiscectomy technique to lower lumbar region. The first, we use epidural analgesia to avoid complications of general anesthesia and can cooperate to the patients. The second step, the patient is placed knee-chest position on the operating table. This placement may cause to maximum expanding of the interlaminar space and laminectomy is not necessary to reach intervertebral space. In this procedure, ligamentum flavum is cutting like a flap shape and retracted medially without removed. Then it is replaced the original positions end of the operation. Finally, the root and epidural space surrounded by authogene lipid guts from subcutaneous tissue. The avoiding of the electrical coagulation and to use haemostatic agents is also advised. Conclusion: This procedure can allow to minimal tissue injury, less pain, early mobilization, less risk of the epidural fibrosis lower lumbar region especially on the L5-S1, L4-5 space.