APPROACH-DECISION
ON VARIOUS LDHS
BESS has an eye .
If you turn your head, you can see the another view.
To see more proximal, bend your head
and try to look upward from the distal.
Ground Plans
LDH can be burst out to central or
downward and it can be solved as we
expected. The difficult position of
LDH for surgeons is up-migration
especially on the Rt. side and
furthermore upper level (L-1-2-3)
because of the narrower lamina and
the smaller spinal canal. For the
down migration on the Lt. or Rt.
side, you can approach the target
with the normal position at the same
side ipsilaterally. And Extraforamina LDH can be approached
from FLA(Issue 4).
But you must think over again
about the up migrated LDH,
foraminal LDH at the level of the L
1-2-3 (or 3-4). At upper level,
limited laminectomy is permitted
and the spinal canal is too narrow
for root-retraction to cause post4
InU’rMind
Think over again the approach on the cases of Rt. side upmigrated LDH at the higher
level (L1-2-3).
: CLA or FLA can be
recommendable in such cases.
operative deterioration of neural
symptom such as foot drop or
limping due to knee extension
weakness. Sometimes up-migrated,
fragmented disc material might not
to be removed totally and be left a
little in postoperative MRI and
residual symptoms for a long time.
In BESS, we can approach the
LDH with less root retraction
or CLA/FLA can be considerable in some cases.