The Intertransverse Approach for far Lateral Lumbar Disk Herniation: Case Series of 60 Patients and Review of the Literature

BACKGROUND AND OBJECTIVES: The purpose of the present work was to review our series of patients with far lateral disk herniations treated by the intertransverse approach. METHODS: Patients undergoing intertransverse approach to treat far-lateral disk herniation by a single surgeon over a 10-year period were identified through the electronic medical record. Additional variables regarding the intraoperative and postoperative course were also collected. Response to treatment was assessed using Odom criteria at the patient's postoperative follow-up. RESULTS: Sixty patients met inclusion criteria. The most frequently treated levels were L3-4 and L4-5 (41.7% and 36.7%, respectively), and 11.7% at L5-S1. The mean age was 56.8 years (SD = 12.6y). Isolated radicular pain was the most common presenting symptom (66%). Two-thirds of patients had mild systemic disease as determined by the American Society of Anesthesiologists score (II). Estimated blood loss ranged from <50 to 600 mL, with a median of 50 mL (IQR 30-120 mL). The mean length of stay was 48h (SD = 46 hours), with 35% of patients (22) undergoing outpatient surgery. The median length of latest postoperative follow-up was 78 days (IQR 34-19 days). Per Odom criteria, most patients had good-to-excellent improvement of preoperative symptoms (80%, N = 48). 8.3% of patients required revision surgery with fusion (N = 5). CONCLUSION: Most patients had good-to-excellent improvement of preoperative symptoms. The paucity of revision procedures in this cohort suggests that the intertransverse approach is durable as it enables direct decompression of the nerve root without destabilizing the motion segment. Further studies are required to compare the efficacy of the intertransverse approach with other approaches.