Ruptured median and paramedian lumbar disk. A review of 243 cases.

Ruptured median and paramedian lumbar disks present special problems for the surgeon, not the least of which is adequate laminectomy to provide satisfactory decompression and release of the disk fragment without trauma to the cauda equina. The surgical technique described was used over a 10-year period in a series of 243 patients and emphasized the principles of sufficient removal of bone and posterolateral approach. Although 72% of patients had complete or partial myelographic block, unilateral symptoms and neurologic signs predominated. Full recovery with minimal or no neurologic deficit was recorded in 85% of patients, with a recurrence rate of 6%. In no patient was neurologic deficit greater than before operation.