Frequency and specific surgical management of far lateral lumbar disc herniations

Abstract

A) Frequency of Far Lateral Lumbar Disc Herniation: The analysis of pre-operative computer-assisted tomograms and myelograms in a series of 694 operated lumbar disc herniations showed that a far lateral disc prolapse occured in 7% of the cases. Within the group of those far laterally herniated discs 3% of the herniations were predominantly located in the intervertebral foramen, whereas 4% of the protruded discs were mainly situated extraforaminally compressing the spinal nerve in its paravertebral course. B) Surgical Management of Extraforaminal Far Lateral Lumbar Disc Herniation: By March 1988 40 patients had been operated on for an extraforaminal disc protrusion making use of an external microsurgical exposure (in two cases by a transmuscular approach and in 38 cases via an enlarged midline approach). A medium-term follow-up of these 40 patients revealed a substantial clinical relief of pain in 34 cases (85%). Based on these gratifying results we regard the external exposure of the extraforaminally protruded disc as the treatment of choice.

Ultra-long-term outcome of surgically treated far-lateral, extraforaminal lumbar disc herniations: a single-center series

“…This is quite in contrast to midline approaches where extensive bone resection is unfailingly required to reach FELDHs. Even though the development of spinal instability after unilateral complete facetectomy is stated to be rather unusual, nevertheless, its occurrence has been reported [9,11,14,24]. Furthermore, these extensive approaches may contribute to continued postoperative discomfort.…”

Extreme lateral lumbar disc herniation in a 12-year child: case report and review of the literature

“…These include midline incisions and subperiosteal muscle dissections with hemilaminectomy and partial or complete facetectomy or paramedian incisions with intermuscular dissections for an intertransverse approach; and combined approaches for LDHs occupying paramedian, foraminal and extraforaminal locations. Instability [15,16] and severe back pain [7] have been reported after an interlaminar approach with facetectomy and spinal fusion has been advocated in every case [17]. In addition, an extraforaminal disc prolapse is often sequestrated [1,12,15,18,19], and many migrate superiorly and laterally.…”

Combined intra-extracanal approach to lumbosacral disc herniations with bi-radicular involvement. Technical considerations from a surgical series of 15 cases

“…As a price to pay for maintaining the facet joint intact, a very lateral herniation must be removed blindly, accepting the risk of leaving disc fragments within the foramen. The numerous ''far-lateral'' approaches proposed for treating extraforaminal herniations [4,12,[14][15][16] share the same drawback-they control only one side of the foramen-if an intraforaminal extension of the herniated disc has to be removed. In a technical note, Di Lorenzo et al [1] proposed removing purely foraminal disc herniations by unroofing the foramen directly through a fenestration of the pars interarticularis.…”

“…Up to 93% of these lesions involve the paramedian space, thus compressing the descending (lower) nerve root [16]. These disc herniations have traditionally been managed through a standard interlaminar approach.…”

“…Laterally located disc herniations occasionally involve the exiting (upper) nerve root either within or outside the neuroforamen. Extraforaminal disc material is conveniently exposed through an extraspinal intertransverse approach [6,13,14,16]; purely intraforaminal disc fragments can be reached from both the intraspinal and extraspinal perspectives [2,4,10].…”