End-lateral disc hernias account for 10% of the symptomatic disc hernias, most commonly localized at L3-L4 and L4-L5 levels. For many years, the surgical treatment of foraminal and extraforaminal lumbar hernias was made through median posterior port by hemilaminectomy and total or partial facetectomy. A number of variations to this technique have been proposed in order to avoid facetectomy and its biomechanical effects, which sometimes cause the onset of low lumbar pain as a result of vertebral instability. The surgical treatment of this pathology through paramedian port, between multifidus and longissimus muscles (Wiltse port), has the advantage of sparing the patient from bone losses and of allowing a more oblique view of the neuroforamen. This port enables, with a minimal L4 root movement, access to L4-L5 disc and its occasional extraforaminal hernias. Our objective is to present a study of the extraforaminal path of L4 root at the intertransversal space L4-L5. For this purpose, 10 cadavers (20 sides) have been dissected for obtaining measurements based on 6 anatomical parameters. Data analysis enables us to conclude that end-lateral disc hernias at L4-L5 level may be accessed with a relative safety through paramedian port.
Intervertebral disc displacement; Radiculopathy; Low back pain; Spinal cord; Laminectomy; Sciatic neuropathy
