Management of lumbar far lateral disc herniation

ABSTRACT

To discuss the characteristics and management of far lateral lumbar disc herniation. The clinical data from 12 patients from 1999-2005 were retrospectively analyzed. Magnetic resonance imaging is the investigation of choice for the diagnosis of lumbar disc prolapsed, with L4/5 level the most common location. Radicular pain was present in all patients and back pain in 75% of patients. Motor weakness was observed in 75% of cases. Midline lumbar incisions with unilateral dissection of muscles was the most frequently used technique, starting with fenestration or interlaminar approach in 11 patients, then either the intertransverse approach [9 cases], or unilateral medical facetectomies [2 cases] were used to remove the rest of the far lateral disc, and the paramedian intertransverse approach was used in only one case. Neurological improvement was observed in 84% of cases and deterioration in neurological states in 16%. Far lateral disc herniation should be included in the differential diagnosis of any back or radicular pain and proper management and experience is needed to achieve good outcome: