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We describe a new surgical route that we call the "crest approach" for treating extraforaminal disc herniation in the lumbar spine. This approach is useful only for the levels above L5-S1. It permits perfect root decompression without any bony resection that would contribute to instability. Muscle retraction and devascularization are reduced. Risk of nerve root lesions is minimal since the herniation is removed before root mobilization. Fifteen patients have been treated using this procedure. In all 15, pain and/or neurologic deficits remitted rapidly with no postoperative complications. In conclusion, the crest approach provides highly satisfactory operating conditions by simplifying exposure and greatly limiting the risk of complications. In our relatively limited experience using this procedure, only satisfactory results have been observed.

A novel paraspinal surgical approach for lumbar lateral extraforaminal root entrapment