Massive lumbar disc herniation treated with a transdural approach and posterior fusion. A case report

• Published in: Interdisciplinary neurosurgery : Advanced techniques and case management Vol. 36; p. 101924
• Main Authors: Sono, Takashi, Nakatani, Kenji, Morizane, Kazuaki, Otsuka, Kazushi, Takatsuka, Kazutaka
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.06.2024; Elsevier
• Subjects: Massive lumbar disc herniation; Posterior fusion; Transdural approach; Transdural approach; Posterior fusion; Massive lumbar disc herniation
• ISSN: 2214-7519; 2214-7519
• DOI: 10.1016/j.inat.2023.101924

•It is difficult to remove massive lumbar disc herniation at the upper levels by the conventional approach.•To gain enough working space, bilateral facetectomy followed by posterior lumbar interbody fusion (PLIF) is necessary.•Transdural approach combined with PLIF is a good surgical method. Lumbar disc herniation (LDH) at the upper levels (L1–2 and L2–3) is different from that at the lower levels with regard to clinical characteristics and surgical outcomes. Discectomy using the transdural approach is a good option for central LDH at the upper levels; however, postoperative instability and recurrence are the major concerns. A 57-year-old woman experienced severe back pain and dysuria. Magnetic resonance imaging (MRI) revealed a massive LDH at the L1–2 level. Despite conservative treatment for 3 months, her low back pain was not relieved. Posterior lumbar interbody fusion (PLIF) with bilateral facetectomy was performed, and the residual LDH was subsequently removed using the transdural approach. The patient’s preoperative symptoms were relieved after surgery. PLIF followed by discectomy using the transdural approach is a safe and useful surgical method to treat a massive LDH at the upper levels.