fenestration

Rebecca,

Good question – fenestration of the disks on either side of the herniated disk is more a general rule rather than a hard and fast one.

There are multiple variables at play in deciding if fenestration is warranted and which disks to fenestrate (length of surgery, location of surgery, health of intervertebral disks, surgeon’s comfort with fenestration, surgeon’s opinion about benefits of fenestration, etc).

Fenestration requires exposing the disk to be fenestrated. When performing decompressive surgery the adjacent disks are already exposed in the surgical site and require relatively little additional dissection to fenestrate. To fenestrate disks, other than the adjacent ones, the surgery site would need to be enlarged (adding more time and tissue trauma). However, if a mineralized/degenerative disk is noted two disk spaces away fenestration is sometimes performed.

Andrew