Abstract

Lumbar discectomy is one of the commonest operation. Many discectomy cases show recurrent disc fragments without symptoms. This brings us the idea that bony decompression of the root (sometimes even without disc removal) may suffice. In this prospectively designed study, we evaluated results of a new technique. Method: 21 patients (age range 33-67, mean 48) with radicular symptoms were operated on using the new technique called microforaminotomy. It consisted of 20-30 mm transverse skin incion on the symptomatic side centered on disc interspace; muscle dissection and application of Caspar retractor; and cretation of a hole (max 10 mm in diameter) on the lamina-facet junction of the cranial lamina using a high-speed drill under operation microscope. This hole generally well matched the location of the exiting root. In 15 cases, the hole itself was sufficient for decompression. In 6 cases, extruded disc fragments were found and removed. Preoperative and 1st month postoperative pain and disability scores were measured using visual analog scale (VAS) and Oswestry Disability Index (ODI). Result: No complication was encountered. Patients were generally discharged next day. Pre- and postoperative VAS (mean 9.8 and 1.7 respectively) and ODI scores (64% vs 14%) showed significant improvements (P <0,001). 19 of 21 patients satisfied with the treatment. Conclusion: Microforaminotomy method aims to decompress the root directly in a less invasive way. Hemipartial laminectomy, resection of the lig. flavum, and wide exposition of the local anatomy is not involved in this technique. Our results support that it may be an alternative technique in selected cases.