Related Experiment Video
Updated: Jan 15, 2026
A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations
Published on: August 7, 2018
Mid-term follow-up of far lateral microdiscectomy-surgical technique, outcomes and reoperation rates
Nigel R Munday1,2, Tom A Linstrom1,2,3, Dean T Biddau1,2,4
1Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia.
Background:
Far lateral disc herniations (FLDHs) are foraminal and extra-foraminal disc prolapses that comprise only 7-12% of all lumbar disc herniations. They compress the exiting nerve root and dorsal root ganglion (DRG) accounting for an increased severity of pain and neurological deficit compared to standard posterolateral and medial foraminal disc prolapses. There is a paucity of data on the mid-to-long-term outcomes and reoperation rates following a far lateral microdiscectomy (FLMD) operation. We report mid-term follow-up of patients undergoing FLMD using a Wiltse muscle-splitting approach that optimises approach angle to the lateral and foraminal disc with minimal facet joint removal and preservation of the pars interarticularis. The aim of this study is to report the mid-to-long-term outcomes and reoperation rates in a cohort of patients undergoing FLMD via a Wiltse approach.
Methods:
Single centre, single surgeon, retrospective analysis of consecutive patients underwent lumbar FLMD. A cohort of 50 patients from one senior spine surgeon were included. Patient-reported outcome measures (PROMs), visual analogue scale (VAS back and leg), Oswestry Disability Index (ODI) and short-form-12 (SF-12), patient satisfaction using Odom's criteria, recurrence and reoperation rates were evaluated preoperatively, at 6 weeks postoperatively, and at last follow-up. All consecutive patients underwent a lumbar FLMD via a paramedian Wiltse approach from January 2010 to December 2021. Minimum follow-up was 3 years.
Results:
The mean patient age was 60.6±14.1 years, body mass index (BMI) 27.9±2.6 kg/m2, and 25 (50.0%) were male. The mean operation time was 77±17 minutes and the mean follow-up was 5.2 years (range, 3-14 years). All PROMs improved significantly from the pre-operative consultation to the last post-operative follow-up (P<0.001). Forty-two (84%) reported excellent or good outcomes. There were no dural tears, nerve root injuries, residual neuropathic pain or infections, and no known iatrogenic pars defects or facet fractures. Eight (16%) patients needed reoperation. Two patients had a revision FLMD within 2 weeks postoperatively. Six patients had interbody fusions at a mean 1.9 years (range, 0.17-3 years) post-index FLMD.
Conclusions:
FLMD via a Wiltse approach is safe and effective for decompressing the exiting nerve root and the DRG, providing excellent visualisation of the pathology and the exiting root, while requiring minimal bone removal. This mid-term follow-up demonstrated over 80% of patients reported early mobilization with excellent or good outcomes. Subsequent interbody fusions were performed for either symptomatic disc degeneration, foraminal stenosis, or both, rather than for instability.
Insights
Far lateral microdiscectomy (FLMD) using the Wiltse approach offers a safe and effective treatment for lumbar disc herniations, with 84% of patients reporting good to excellent outcomes. This technique provides excellent visualization and minimal bone removal, leading to significant pain relief and improved function.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spine Surgery
Background:
- Far lateral disc herniations (FLDHs) are rare lumbar disc issues compressing the exiting nerve root and dorsal root ganglion (DRG).
- FLDHs cause more severe pain and neurological deficits than standard disc prolapses.
- Limited data exists on the long-term outcomes of far lateral microdiscectomy (FLMD).
Purpose of the Study:
- To evaluate the mid-to-long-term outcomes and reoperation rates of FLMD using the Wiltse approach.
- To assess the safety and efficacy of FLMD in treating FLDHs.
- To analyze patient-reported outcomes and satisfaction following FLMD.
Main Methods:
- Retrospective analysis of 50 consecutive patients undergoing lumbar FLMD via a Wiltse approach.
- Data collected included patient-reported outcome measures (PROMs), visual analogue scale (VAS), Oswestry Disability Index (ODI), and short-form-12 (SF-12).
- Outcomes were assessed preoperatively, at 6 weeks, and at the last follow-up (minimum 3 years).
Main Results:
- 84% of patients reported excellent or good outcomes at a mean follow-up of 5.2 years.
- Significant improvements in all PROMs were observed postoperatively (P<0.001).
- 8% of patients required reoperation, with 6 undergoing subsequent interbody fusions for degeneration or stenosis.
Conclusions:
- FLMD via the Wiltse approach is safe and effective for treating FLDHs.
- The technique provides excellent visualization and requires minimal bone removal.
- Over 80% of patients experienced early mobilization and good-to-excellent outcomes.
