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Transforaminal approach in lumbar disc herniations: transforaminal microdiscectomy (TFMD) technique

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SCHOOL OF MEDICINE
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Dalbayrak, Sedat
Yaman, Onur
Yılmaz, Mesut

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Lomber disk patolojilerine transforaminal yaklaşım: transforaminal mikrodiskektomi (TFMD) tekniği

Abstract

AIM: The endoscopic foraminal approach in foramina!, lateral and far-lateral disc hernias, is a contemporary minimal invasive approach. This study was performed to show that the approach is possible with using the microscope without an endoscope, and even intervention on the discs within the spinal canal is possible by having access through the foramen. MATERIAL and METHODS: Forty-two cases with disc hernias in the medial of the pedicle were included in this study. Surgeries were performed with the transforaminal approach and microsurgically. Extraforaminal disc hernias were not included in the study. Access was made through the Kambin's triangle. The foramen was enlarged and the spinal canal was entered. RESULTS: The procedure took 65 minutes on average, and the mean bleeding amount was about 100 ml. Patients were mobilized within the same day postoperatively. No permenant complications were seen. Follow-up periods ranged between 5 and 84 months and the mean follow-up period was 30.2 months. CONCLUSION: Transforaminal microdiscectomy is a method that can be performed in any clinic with standard neurosurgical instruments. It does not require additional equipment or a high amount of investment. Application of transforaminal inter-body fusion is possible when required. / bu yaklaşımın rahatlıkla yapılabileceğini, hatta nöral foramenden girerek spinal kanal içindeki disklere de müdahale edilebileceğini gösteren teknik tanımlanmaktadır. YÖNTEM ve GEREÇLER: Pedikül mediyalinde olan ve transforaminal yolla mikroşirürjikal yaklaşım uygulanan 42 disk hernisi olgusu çalışmaya alındı. Pedikül lateralinde olan disk hernileri çalışmaya dahil edilmedi. Kambin üçgeninden yaklaşıldı, foramen genişletilerek spinal kanal içine girildi. Standart aletlerle transforaminal mikrodiskektomi (TFMD) uygulandı. BULGULAR: İşlem ortalama 65 dakika sürdü ve ortalama kanama miktarı 100 ml idi. Hastalar postoperatif aynı gün mobilize edildiler, ertesi gün taburcu oldular. Kalıcı komplikasyon görülmedi. Takip süresi 5-84 ay arasında olup, ortalama takip süresi 30,2 ay idi. SONUÇ: Transforaminal mikrodiskektomi standart nöroşirürji donanımı olan her klinikte uygulanabilecek bir yöntemdir. Ek bir donanım ve yüksek maliyetler gerektirmez. Gereğinde transforaminal cisimler arası (interbody) füzyon veya nukleus protezi uygulanabilmesi mümkündür.

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Turkish Neurosurgical Soc

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Clinical neurology, Surgery

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Turkish Neurosurgery

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10.5137/1019-5149.JTN.8197-13.1

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