{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T09:35:01Z","timestamp":1769506501157,"version":"3.49.0"},"reference-count":15,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2007,9]]},"abstract":"<jats:p>\u2713Disc herniations of the upper lumbar spine (L1\u20132 and L2\u20133) have a frequency of 1 to 2% of all disc herniations. During posterior discectomy after laminectomy, significant manipulation of the exiting nerve root is unavoidable because of the narrow lamina and the difficulty in mobilizing the nerve root. The authors adopted a transdural approach in patients with calcified central disc herniation at the L1\u20132 level to reduce the risk of nerve root injury.<\/jats:p>\n<jats:p>Four patients suffering from radiating pain together with back pain were treated using the transdural approach. Pre-operative neuroimaging studies revealed severe central disc herniation with calcification at the L1\u20132 level. After laminectomy or laminotomy, the incised dura mater was tacked, and the cauda equina rootlets were gently retracted. An intentional durotomy was performed over its maximal bulging of the ventral dura. After meticulous dissection of dense adhesions between the disc herniation and the dural sac, adequate decompression with removal of calcified disc fragments and osteophytes was accomplished.<\/jats:p>\n<jats:p>Clinical symptoms improved in all patients. Postoperative permanent cerebrospinal fluid leakage and pseudomeningocele were not observed, and no patient had a progressive lumbar deformity at an average follow-up of 53 months. Transient mild motor weakness and sensory change were observed in two patients postoperatively; however, these symptoms resolved completely within 1 week.<\/jats:p>\n<jats:p>The posterior transdural approach offers an alternative in central calcified upper lumbar disc herniation when root retraction is dangerous.<\/jats:p>","DOI":"10.3171\/spi-07\/09\/370","type":"journal-article","created":{"date-parts":[[2008,1,24]],"date-time":"2008-01-24T12:23:52Z","timestamp":1201177432000},"page":"370-374","source":"Crossref","is-referenced-by-count":32,"title":["Transdural approach for calcified central disc herniations of the upper lumbar spine"],"prefix":"10.3171","volume":"7","author":[{"given":"Jeong-Wook","family":"Choi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jung-Kil","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyung-Sub","family":"Moon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyuk","family":"Hur","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yeon-Seong","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soo-Han","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-0070370","series-title":"J Spinal Disord","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1097\/00002517-199306040-00009","article-title":"Upper lumbar disc herniations","volume":"6","author":"Albert","year":"1993"},{"key":"b2-0070370","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1080\/02688690120072540","article-title":"Transradicular interfascicular approach for lumbar microdiscectomy: a useful technique in difficult circumstances","volume":"15","author":"Choudhari","year":"2001"},{"key":"b3-0070370","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1227\/00006123-198101000-00020","article-title":"Intradural lumbar disc hernia: description of three cases","volume":"8","author":"Ciappetta","year":"1981"},{"key":"b4-0070370","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1001\/jama.1942.02830230008002","article-title":"Serious complications of ruptured intervertebral disks","volume":"119","author":"Dandy","year":"1942"},{"key":"b5-0070370","series-title":"J Indian Med Assoc","first-page":"199","article-title":"Protrusion of upper lumbar intervertebral discs (long term follow-up of operated cases)","volume":"89","author":"Dinakar","year":"1991"},{"key":"b6-0070370","series-title":"Neurosurgery","first-page":"634","article-title":"Transdural approach to the anterior spinal canal in patients with cervical spondylotic myelopathy and superimposed central soft disc herniation","volume":"34","author":"Fox","year":"1994"},{"key":"b7-0070370","series-title":"Spine","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1097\/00007632-200204010-00008","article-title":"Microsurgical transdural discectomy with laminoplasty: new treatment for paracentral and paracentroforaminal cervical disc herniation associated with spinal canal stenosis","volume":"27","author":"Fujimoto","year":"2002"},{"key":"b8-0070370","series-title":"Neurosurgery","first-page":"235","article-title":"En bloc laminoplasty performed with threadwire saw","volume":"48","author":"Hara","year":"2001"},{"key":"b9-0070370","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"S30","DOI":"10.1007\/PL00010019","article-title":"Five years' experience of the retroperitoneal lumbar and thoracolumbar surgery","volume":"9","author":"Hovorka","year":"2000"},{"key":"b10-0070370","series-title":"Spine","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1097\/00007632-199007000-00012","article-title":"High lumbar disc degeneration. Incidence and etiology","volume":"15","author":"Hsu","year":"1990"},{"key":"b11-0070370","series-title":"J Spinal Disord","first-page":"75","article-title":"Considerations for surgical treatment of patients with upper lumbar disc herniations","volume":"11","author":"Ido","year":"1998"},{"key":"b12-0070370","series-title":"Spine","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1097\/00007632-199601010-00008","article-title":"Expansive laminoplasty for cervical radiculomyelopathy due to soft disc herniation","volume":"21","author":"Iwasaki","year":"1996"},{"key":"b13-0070370","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/j.surneu.2004.06.026","article-title":"Transthoracic discectomy without interbody fusion","volume":"63","author":"Krauss","year":"2005"},{"key":"b14-0070370","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1227\/01.NEU.0000129548.14898.9B","article-title":"The unique characteristics of \u201cupper\u201d lumbar disc herniations","volume":"55","author":"Sanderson","year":"2004"},{"key":"b15-0070370","series-title":"Spine","doi-asserted-by":"publisher","first-page":"E512","DOI":"10.1097\/00007632-200111150-00021","article-title":"Symptoms of thoracolumbar junction disc herniation","volume":"26","author":"Tokuhashi","year":"2001"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/7\/3\/article-p370.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/7\/3\/article-p370.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/7\/3\/article-p370.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T23:26:53Z","timestamp":1681601213000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/7\/3\/article-p370.xml"}},"subtitle":["Technical note"],"short-title":[],"issued":{"date-parts":[[2007,9]]},"references-count":15,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/spi-07\/09\/370","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2007,9]]}}}