Work

How I do it: microsurgical extraforaminal sequestrectomy through a midline intertransverse approach

Year: 2026

Type: article

Abstract: BACKGROUND: Several surgical approaches exist for extraforaminal (far lateral) lumbar disc herniations, including paraspinal Wiltse-type, interlaminar, lateral intertransverse, and combined medial-lateral techniques. METHOD: We present microsurgical extraforaminal sequestrectomy through a midline intertransverse approach, chosen for familiar anatomy, minimal facet joint resection, and avoidance of a muscle-splitting trajectory. Unilateral subperiosteal dissection exposes the isthmus, facet margin, and transverse processes with the intertransverse ligament; the facet margin is removed with a straight osteotome, the ligament resected, the intertransverse artery coagulated, and the nerve root and disc space exposed for sequestrectomy. CONCLUSION: This approach provides effective sequestrectomy while preserving spinal stability using familiar midline anatomy.

Source: Acta Neurochirurgica

DOI: 10.1007/s00701-026-07040-w

Authors: Victor E. Staartjes, Adrian Elmi-Terander, Gunnar Nilsson, Mario Ruiz

Institutions: University of Zurich, Karolinska Institutet, University Hospital Zurich, Uppsala University, Örebro University

Language: English

Topic: Spine and Intervertebral Disc Pathology

Subfield: Pathology and Forensic Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,990