Far lateral disc herniations treated by microscopic fragment excision. Techniques and results

Area of Science:

• Neurosurgery
• Spinal Surgery
• Orthopedic Surgery

Background:

• Far lateral disc herniations can cause radiculopathy, affecting lumbar nerve roots near the intervertebral foramen.
• This anatomical region is less familiar to surgeons compared to paramedian herniations.
• Surgical approaches include transfacetal or muscle-splitting techniques that spare the facet.

Purpose of the Study:

• To describe the microscopic surgical technique for excising far lateral disc herniations.
• To evaluate the outcomes of surgical treatment for far lateral disc herniations using a muscle-splitting approach.

Main Methods:

• Retrospective review of 31 consecutive patients undergoing paraspinal, muscle-splitting incision for far lateral disc herniations.
• Surgical technique involves a muscle-splitting approach that spares the facet.
• Follow-up at a minimum of 2 years included history, pain questionnaires, visual analogue scales, physical examination, and radiographs.

Main Results:

• Of 25 evaluated patients (minimum 2-year follow-up), 48% had excellent results, 32% had good results, and 20% had fair or poor results.
• Low back pain and dysesthesias were identified as causes of unsatisfactory outcomes.
• No postoperative radiographic signs of spinal instability were observed.

Conclusions:

• The described microscopic technique for far lateral disc herniation excision is effective, with encouraging overall results.
• The approach aims to minimize manipulation of the dorsal root ganglion, potentially reducing dysesthetic pain.
• Understanding the anatomy lateral to the pedicle is crucial for successful surgical outcomes.