Türk Nöroşirürji Dergisi 2015 , Vol 25 , Num 3
Surgical Management of Giant Lumbar Disc Herniations
Serdal ALBAYRAK1, Sait ÖZTÜRK2, Necati ÜÇLER3
1Elazığ Eğitim ve Araştırma Hastanesi, Beyin ve Sinir Cerrahisi Kliniği, Elazığ, Türkiye
2Fırat Üniversitesi, Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı, Elazığ, Türkiye
3Adıyaman Eğitim ve Araştırma Hastanesi, Beyin ve Sinir Cerrahisi Kliniği, Adıyaman, Türkiye
AIM: In addition to the significance of the deficits caused by sequestrated discs due to neural compression, surgical treatment modalities of sequestrated discs are also important. Various surgical techniques in our patients with sequestrated disc are presented and discussed in this study.

MATERIAL and METHODS: Twenty-nine patients with inferiorly migrated giant sequestrated disc fragment that reached one corpus length or more were included. Four diff erent types of surgical methods were used. Type I was Partial hemilaminectomy (PHL)+foraminotomy (For) + sequestrectomy and microdiscectomy (SM), Type II was PHL+ For + superior PHL (sPHL) of the upper part of the lower adjacent vertebrae + SM. Type III was PHL+ For + superior and inferior 1/3 part (siPHL) of lower adjacent vertebrae + SM. Type IV was PHL + hemilaminectomy to lower adjacent vertebrae + SM. Patients were followed up at 1, 3, 6 and 12 months.

RESULTS: Type IV surgery was performed only for one of the patients with L3-4 giant sequestrated disc and Type II surgical approach was suff icient for the other 3 cases. Type I, Type II, Type III, and Type IV surgical methods were performed for 8, 6, 4 and 2 cases respectively in patients with L4-5 disc. Type II surgery was adequate for all patients with L5-S1 giant sequestrated discs.

CONCLUSION: The ultimate aim in disc surgery is maintaining adequate decompression and the possibility of changing the surgical technique intraoperatively should be kept in mind for good results. Anahtar Kelimeler : Surgical technique, Lumbar disc herniation, Microdiscectomy, Sequestrated disc