A New Surgical Procedure for Lumbar Disc Herniation Causing Less Tissue Damage Through a Microsurgical Approach

Abstract

Experience shows that there is an undesirably high incidence of substantial (unfortunately, sometimes also permanent) local back complaints after surgical treatment of lumbar disc herniation. The quality of the results of surgery is thereby reduced and sometomes indeed put in question. We believe that a considerable proportion of the complaints must be attributed to surgical trauma, in particular to muscle damage. This opinion is supported by the results of experienced surgeons such as KUHLENDAHL, LANGE, LOVE, YOUMANS and others (8, 9, 10, 11, 15, 19, 5, 20), who have long advocated an intervention which is as accurate, restricted in extent and as gentle as possible. It is also based on our own observations over many years. There is no doubt that the indication, extent of the surgical approach, gentle procedure and the experience of the surgeon have a direct relationship with the quality of the operation results. The hitherto practised surgical method requires a disproportionately large access as compared to the dimensions of the surgical target area (about 10: 1 and more). This applies particularly to the generally recommended exploration of the two lower segments (1, 2, 3, 4, 6, 7, 12, 13, 14, 16, 17, 18). It is known to be unnecessary in 90 to 95 percent of the cases. The diagnostic procedures available today ensure a sufficiently safe selection of cases with several herniations.