Midline sequestrectomy for far lateral lumbar disc herniation: a case series and technique description

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Surgery

Background:

• Far lateral lumbar disc herniation (FLLDH) is a rare spinal pathology.
• Surgical intervention is often necessary when conservative treatments fail.
• Limited access to advanced microsurgical equipment poses challenges in resource-limited settings.

Purpose of the Study:

• To evaluate the clinical outcomes and feasibility of midline fragment-only sequestrectomy for FLLDH.
• To assess the effectiveness of this approach in resource-limited environments.

Main Methods:

• Retrospective case series of 35 patients with MRI-confirmed FLLDH.
• Treatment involved midline fragment-only sequestrectomy under microscopic visualization.
• Limited bone removal without hemilaminectomy or facetectomy was performed.
• Clinical outcomes assessed using Visual Analog Scale (VAS) and Macnab criteria.

Main Results:

• Mean operative time was 30 minutes with minimal blood loss (40 ml).
• All patients were discharged within 16 hours post-surgery.
• At 24-month follow-up, no recurrences or instability were observed.
• 82.8% of patients reported excellent outcomes, and 17.2% reported good outcomes.

Conclusions:

• Midline sequestrectomy is a safe and cost-effective option for FLLDH in resource-limited settings.
• Favorable short- and long-term outcomes were achieved.
• This technique offers a viable alternative where advanced equipment is scarce.