Surgical Treatment of Far Lateral Lumbar Disc Herniation: Outcomes of the Safe and Simple Midline Approach

Kaya, Mustafa; Keskin, Emrah; Ceylan, Davut; Kacira, Tibet; Kacira, Özlem Kitiki

doi:10.7759/cureus.27907

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…Despite this, our study shows that a MIS far lateral approach with minimal bony removal is well-tolerated, safe, and can provide a high rate of symptomatic relief while preserving the posterior stabilizing elements of the lumbar spine. Our mean LOS of 1.3 ± 1.4 days is consistent with findings from other studies employing MIS techniques for far lateral disc herniation surgery, suggesting that our approach maintains the efficiency and reduced hospitalization benefits characteristic of minimally invasive spine surgeries [28,29]. In our series, almost all of the patients in the cohort had subjective improvement in their symptoms (93.5%), and more than half ultimately had complete resolution at follow-up (58.7%).…”

Section: Discussionsupporting

confidence: 88%

Minimally Invasive Far Lateral Lumbar Discectomy With Modified Technique: Symptomatic Relief and Intersegmental Stability Study

Laskay,

Jarrell,

Salehani

et al. 2024

Cureus

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Objective: To evaluate the use of a modified minimally invasive surgery (MIS) technique for far lateral lumbar discectomy (FLDH) that minimizes the degree of bony drilling required for nerve root decompression, increasing postoperative pain reduction rate with reduced risk of iatrogenic spinal instability.Summary of background data: FLDH accounts for approximately 10% of all lumbar disc herniations and is increasingly recognized in the era of advanced imaging techniques. These disc herniations typically result in extra-foraminal nerve root compression. Minimally invasive spine techniques are increasingly performed with various degrees of foraminal and facet removal to decompress the affected nerve root.Methods: The study design involves a single institutional, retrospective cohort technical review. The review was completed of all patients undergoing MIS far lateral lumbar discectomy between 2010 and 2020. Crosssectional, summary statistics were calculated for all variables. Counts and percentages were recorded for categorical variables and mean and standard deviations were calculated for continuous variables.Results: A total of 48 patients underwent MIS far lateral lumbar discectomies (FLLD) from 2010 to 2020. The mean age was 63 ± 11.5 years (60.4% males), the mean BMI was 28.5 ± 5.5, and 20.8% smokers. The most common presenting complaint was both low back and radicular pain (79.2%) with 8.3% of patients suffering from motor weakness preoperatively. The mean follow-up time was 4.3 ± 2.7. The mean length of stay was 1.3 ± 1.4 days with 77.1% of patients discharged postoperative day one. Forty-three patients (93.5%) had improvement in their symptoms. Twenty-seven (58.7%) had complete resolution in 2.6 months on average. Six patients (13%) had immediate symptom resolution postoperatively.Conclusions: Our modified technique for FLLD allows MIS access to the extra-foraminal site of nerve root compression without the need for bony drilling. This minimizes postoperative pain and reduces the risk of iatrogenic spinal instability without sacrificing symptom resolution.

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Section: Discussionsupporting

confidence: 88%

Minimally Invasive Far Lateral Lumbar Discectomy With Modified Technique: Symptomatic Relief and Intersegmental Stability Study

Laskay,

Jarrell,

Salehani

et al. 2024

Cureus

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“…The management of FLLDH has traditionally been a complex endeavour within spinal care. When conservative treatments fail, surgical intervention could be a choice with many techniques that have developed with studies like midline or paramedian surgery, tubular approach, and endoscopic technique [5][6][7][8][9]. These approaches are limited due to various patient-related factors such as overall health, age, or specific anatomical considerations [10,11].…”

Section: Introductionmentioning

confidence: 99%

Transforaminal Epidural Injection for Far Lateral Lumbar Disc Herniations: An Alternative to Surgery or Just a Delay?

Serifoglu,

Etli

2024

Cureus

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Objective: Far lateral lumbar disc herniations (FLLDH) are known for causing severe and persistent radicular pain due to direct nerve root and dorsal root ganglion compression. This study evaluates the effectiveness of transforaminal epidural steroid injection (TFSI) in patients with FLLDH, assessing its role as a potential alternative to surgery. Methods: The study retrospectively analyzed 42 patients with radicular pain caused by FLDH, confirmed via lumbar magnetic resonance imaging, who had not benefited from conservative treatment. All patients underwent TFSI, and their pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were compared with scores at one, two, and three months post-procedure. Results: The study group comprised 19 males (45.23%) and 23 females (54.77%), with a mean age of 51.9 ± 11.63 years (range 29-76 years). The most common herniation levels were L4-L5 (22 patients), followed by L5-S1 (15 patients) and L3-L4 (five patients). The mean VAS score decreased significantly from 8.58 ± 0.63 to 2.89 ± 1.87 over three months (p = 0.001). Similarly, the mean ODI score significantly reduced from 61.29 ± 6.72 to 16.88 ± 11.25 (p = 0.001). However, eight of the 42 patients (19.04%) underwent surgery within three months due to lack of benefit from TFSI. Conclusion: Our study sheds light on the significant potential of TFSI as a treatment option for FLLDH. The marked improvement in pain and functional capacity, as evidenced by the substantial decrease in VAS and ODI scores, suggests that TFSI can be an effective non-surgical intervention for a majority of patients suffering from FLLDH. However, a notable proportion of patients may still require surgery, indicating that TFSI might not be a definitive alternative but can be an effective interim treatment in managing FLLDH.

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Extraforaminal lumbar disk herniation (E-LDH) constitutes 7%-12% of all types of lumbar disk herniations [1,2]. In the case of E-LDH, the herniated disk protrudes beyond the neuroforamen, compressing the nerve roots and resulting in symptoms such as lower extremity pain (Figure 1A) [3].

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confidence: 99%

Full-Endoscopic Extraforaminal Approach for Extraforaminal Herniated Intervertebral Disc Disease: Exploring Challenging Case

Lee,

Chang,

Sun

et al. 2024

J Minim Invasive Spine Surg Tech

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Extraforaminal lumbar disk herniation (E-LDH) constitutes a challenging subset of lumbar disk herniations. Minimally invasive methods like full-endoscopic lumbar discectomy provide benefits but carry risks of complications, such as postoperative dysesthesia and nerve root injury. A 62-year-old male with comorbidities presented with severe leg pain due to left L3/4 E-LDH. An L3 nerve block, guided by fluoroscopy, was performed with the patient in a right decubitus position. After alleviating the pain, the patient was placed in a prone position to undergo the extraforaminal full-endoscopic procedure under local anesthesia. The tip of the needle was targeted to the base of the superior articular process (SAP). Foraminoplasty was precisely performed with a high-speed diamond burr at the base of the SAP, facilitating the removal of the extraforaminal portion of the herniated disc. The procedure yielded immediate relief (visual analogue scale score reduced from 10 to 0). There was no leg pain or associated back pain at the 6-month follow-up. This approach demonstrates the feasibility of an extraforaminal full-endoscopic technique for E-LDH, overcoming challenges associated with the uncooperative patient due to the severe leg pain. However, the technique demands technical proficiency and warrants further research to establish its broader applicability.

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Surgical Treatment of Far Lateral Lumbar Disc Herniation: Outcomes of the Safe and Simple Midline Approach

Cited by 4 publications

References 21 publications

Minimally Invasive Far Lateral Lumbar Discectomy With Modified Technique: Symptomatic Relief and Intersegmental Stability Study

Minimally Invasive Far Lateral Lumbar Discectomy With Modified Technique: Symptomatic Relief and Intersegmental Stability Study

Transforaminal Epidural Injection for Far Lateral Lumbar Disc Herniations: An Alternative to Surgery or Just a Delay?

Full-Endoscopic Extraforaminal Approach for Extraforaminal Herniated Intervertebral Disc Disease: Exploring Challenging Case

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