Far lateral microdiscectomy: a minimally-invasive surgical technique for the treatment of far lateral lumbar disc herniation

Abstract

Lumbar disc herniation arises when the annulus fibrosus of the vertebral disc fails, thus allowing displacement of the nucleus pulposus and other tissue. The term far lateral is used variably in the literature and usually refers to an extraforaminal displacement in the peridiscal zone peripheral to the sagittal plane of the most lateral part of the pedicle at the same level. Non-surgical treatments of far lateral disc herniation include physical therapy, anti-inflammatory medication, and corticosteroid injections. Where these conservative measures fail, surgical intervention may be required. Several surgical techniques for the treatment of far lateral herniations have been investigated, including total or medial facetectomy, laminectomy, hemilaminectomy, approaches through the pars interarticularis, and lateral approaches between the transverse processes via the intertransverse muscle and ligament. We present our far lateral microdiscectomy technique which involves accessing the nerve root lateral to the foramen through a small paramedian incision and use of an operating microscope. Far lateral microdiscectomy offers the prospect of better long-term results than other surgical techniques because of less extensive muscle dissection and preservation of the integrity of the facet joint.

Minimally invasive surgical techniques for the therapy of far lateral disc herniation in middle-aged and elderly patients

“…FLDH rarely causes compression of the dural sac, cauda equina and dysfunction of the bowel and bladder. In the current research, the average patient age was 63.3 years old (range from 57 to 82), which is consistent with that in previous studies [11] and shows that FLDH predominately occurs in middle-aged and elderly patients. Although conservative treatment can occasionally be effective, surgery is usually required [12].…”

“…Far lateral disc herniation (FLDH) is also known as foraminal, intraforaminal, or extreme lateral disc herniation, which is defined as a disc herniation or prolapse that resides lateral and beneath to the upper and lower pedicles and compresses the exiting root and ganglion [10,11]. FLDH rarely causes compression of the dural sac, cauda equina and dysfunction of the bowel and bladder.…”

Annular closure device for disc herniation: meta-analysis of clinical outcome and complications

“…When simple measures fail to resolve patient symptoms a discectomy using various surgical approaches (e.g. open discectomy, endoscopic and microdiscectomy) are used to remove the herniated IVD and decompress the symptomatic nerve [ 4 , 5 ].…”

Retrospective Analysis of Paraspinal Muscle-Splitting Microscopic-Assisted Discectomy Versus Percutaneous Endoscopic Lumbar Discectomy on Patients in the Treatment of Far-Lateral Lumbar Disc Herniation

“…There are minimally invasive surgical treatments for FLLDH, including microendoscopic decompression of the endoscopic to minimize the damage to facet joints, muscles, and ligaments [26] . Less muscle trauma and fewer osteotomies reduce lumbar back pain and adjacent disc degeneration, reducing lumbar instability and fusion [27] .…”