Surgical treatment of far lateral lumbar disc herniation: a safe and simple approach

Abstract

Lumbar discectomy is one of the most commonly performed neurosurgical procedure. Far lateral disc herniations (FLDH) make up a minor portion of the total discectomy workload for spine surgeons. Due to their lower incidence, as well as their different anatomical positioning compared to the more common para-median disc herniation, the surgical procedures involved in releasing the neural compression caused by FLDHs are often challenging and at times frustrating to most spine surgeons, resulting in suboptimal outcomes for the patient related to the higher risk of spinal instability from facet joint disruption and may even be associated with nerve root injury. We discuss here a safe and simple approach to tackle FLDH.

Clinical Presentation and Outcomes of Patients With a Lumbar Far Lateral Herniated Nucleus Pulposus as Compared to Those With a Central or Paracentral Herniation

“…In addition, inherently difficult anatomic access to the lateral interpedicular compartment may increase risk of causing nerve damage, or damaging the overlying facet joint, which can place the patient at risk of spine instability, resulting in spinal fusion surgery in the future. 1,2 However, despite the notion that far lateral HNP may be associated with a technically more difficult surgical procedure, our study has found that patients presenting with far lateral disc herniations can expect similar outcomes to patients presenting with central/paracentral herniations with no increased risk of reoperation. This information can be used in support of surgical treatment for far lateral HNP, as previous literature has suggested that conservative management may result in relatively high non-operative success rates.…”

“…Lumbar discectomy for treatment of lumbar radiculopathy remains one of the most common surgical procedures in the United States. 1,2 The common place nature of this procedure makes it important to understand the outcomes expected after specific subtypes of lumbar disc herniation. While the natural course of paracentral and central disc herniations is well documented, less is known about outcomes following far lateral HNP.…”

“…Lumbar discectomy for the treatment of lumbar radiculopathy from nerve root compression is the most commonly performed neurosurgical procedure with more than 300 000 cases yearly in the United States. 1,2 Lumbar disc herniation remains one of the main factors resulting in an estimated 80% of Americans experiencing low back pain during their lifetime. Lumbar disc herniations are often broadly classified based on their axial location, including central, paracentral, and far lateral.…”

Percutaneous Endoscopic Lumbar Discectomy for Far Lateral L5/S1 Disc Herniation With High Iliac Crest

“…Far lateral lumbar disc herniation (FLLDH), also called extraforaminal lumbar disc herniation, is a special type of lumbar disc herniations (LDHs) and rstly described by Abdullah in 1974 [1]. It consists of foraminal and extraforaminal LDHs, and accounts for 0.7%~11.7% of all LDHs [2,3]. The pathogenesis of FLLDH is different from that of intraspinal central or paracentral disc herniations.…”

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

“…F ar lateral lumbar disc herniation (FLDH), in which the herniated fragment migrates to the underneath and lateral side of the facet joint, is also known as foraminal, intraforaminal or extreme lateral disc herniation in the literature 1 . FLDH is detected in 0.7-12% of all lumbar disc herniations [1][2][3][4] in which the nerve root compression occurs at the same level of herniated disc, rather than at inferior root as in median and paramedian disc herniations (Figure 1). Because of FLDH locates at the outside of spinal canal, it can be hidden and unrecognisable by routine conventional imagings.…”