The Extraforaminal Approach for the Management of Far Lateral Lumbar Disc Herniation

Abstract

Background Data: Far lateral lumbar disc herniation accounts for 1-12% of all lumbar disc herniations. Every aspect of management of this unique type of lumbar disc herniation is challenging for spine surgeons, and no consensus has been reached for the best surgical approach and technique to use.Purpose: The purpose of this study is to evaluate the extraforaminal approach, which is a less invasive approach, for the treatment of far lateral lumbar disc herniation.Study Design: A prospective case series.Patients and Methods: Of 501 lumbar disc prolapse patients treated surgically in our department between September 2013 and August 2015, 15 patients presented with far lateral lumbar disc herniation. These 15 patients (11 males and 4 females, mean age 46.80 ± 8.08 years) were treated surgically using the extraforaminal approach and were prospectively followed for 1 year. The study was approved by the Institution Ethical Committee, and all patients signed an informed consent form. Clinical and functional outcomes were assessed using VAS and ODI scores and MacNab’s criteria. Follow-up MRI was performed at 1 year. Results: Far lateral lumbar disc herniation accounted for 3% of all lumbar disc herniation patients treated surgically in our department. The mean back pain VAS score improved from 6.46 preoperatively to 1.06 at the 1-year follow-up evaluation (P=0.001). The mean leg pain VAS score improved from 7.40 preoperatively to 1.06 at the 1-year follow-up evaluation (P=0.001). The mean ODI score improved from 30.20 preoperatively to 2.80 at the 1-year follow-up evaluation (P=0.001). According to MacNab’s criteria, 12 patients (80%) had excellent outcomes, 3 (20%) had good outcomes, and no patients showed fair or poor outcomes at the final follow-up evaluation at 1 year.Conclusion: The extraforaminal approach seems to be a safe, less traumatic and less destabilizing approach for managing far lateral lumbar disc herniation and can lead to a better outcome than traditional approaches. (2017ESJ129)