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Surgical treatment for the far lateral herniated lumbar disc
W F Donaldson1, M J Star, R P Thorne
1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pennsylvania.
Spine
|August 1, 1993
Summary
Surgery for far lateral herniated nucleus pulposus in older adults shows encouraging pain relief and motor function improvement. This study details a pars interarticularis sparing surgical approach for this specific lumbar disc herniation.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Far lateral herniated nucleus pulposus (HNP) is a less common spinal disc pathology.
- It typically affects older patients and occurs at higher lumbar levels.
- Patients often present with significant radiculopathy and motor weakness.
Purpose of the Study:
- To describe a pars interarticularis sparing surgical technique for far lateral HNP.
- To evaluate the clinical outcomes of this surgical approach.
- To characterize the typical patient profile and affected disc levels.
Main Methods:
- Retrospective review of 29 patients undergoing surgery for far lateral HNP.
- Description of a novel surgical approach preserving the pars interarticularis.
- Assessment of preoperative and postoperative symptoms, including pain and motor function.
Main Results:
- The L4-5 disc was the most frequent herniation level (59%).
- 72% of patients reported good or excellent pain relief postoperatively.
- 71% of patients with preoperative motor weakness showed improvement or resolution of weakness.
Conclusions:
- The pars interarticularis sparing technique provides direct visualization and effective treatment for far lateral HNP.
- This approach yields outcomes comparable to those for posterolateral HNP in similar patient age groups.
- Far lateral HNP surgery in older patients at high lumbar levels can lead to significant symptom improvement.