Small gets Smaller: Feasibility of 14mm Tubular Retractor in the Management of Simple and Complex Cases of Lumbar Disc Herniations

Presented at SMISS Annual Forum 2018
By Arvind Kulkarni MS(ORTH) Dip(ORTH) FCPS Dip(SICOT)
With Andrew Faramand , Nitin Agarwal , David J Salvetti , David K Hamilton , David O Okonkwo , Adam S. Kanter ,

Disclosures: Arvind Kulkarni MS(ORTH) Dip(ORTH) FCPS Dip(SICOT) None Andrew Faramand None, Nitin Agarwal None, David J Salvetti None, David K Hamilton None, David O Okonkwo None, Adam S. Kanter None,


The utility and benefits of tubular retractors in prolapsed disc cases is well-established and time-honored. While 16mm and 18mm diameter tubular retractors are the most frequently utilized ports, there is no published literature on the use of 14mm tubular retractor for lumbar disc herniations.


The authors aim to check the feasibility and outcomes of discectomy performed through a 14 mm tubular retractor.


We included 22 patients presenting with lower limb radicular pain with MRI evidence of herniated nucleus pulposus and failed conservative treatment. All patients were operated by 14mm tube from December 2017 to April 2018. The results were evaluated by using VAS (Visual Analogue Scale) for back and leg pain and ODI (Oswestry Disability Index) and followed up at 1 week, 6 weeks, 3 months interval.


The mean age was 40.5 yrs (range 23-65 years) with 13 males and 9 females. All but one patient had immediate relief after the surgery and satisfactory outcome on follow-up. The mean VAS (leg) improved from 8.6 to 2.5 and the mean VAS (back) improved from 7.8 to 3.4 at 6 weeks follow-up. The mean operative-time was 53.5 minutes (range 20-90 minutes). Dural punctures, nerve-root injuries and surgical-site infections occurred in none. Average blood loss was 45 ml (range 30-70 ml). Out of 22 patients, one patient had a large central disc herniation, two had migrated disc and one had an extra-foraminal disc herniation.


A 14mm tubular retractor achieves the goals of surgery with minimal trauma, smaller incision, minimal operative time and blood loss. The pathologies addressed include not only simple disc herniations but also large central disc herniations, extra-foraminal disc and migrated disc herniations.