Sd. Hodges et al., The surgical treatment of far lateral L3-L4 and L4-L5 disc herniations - Amodified technique and outcomes analysis of 25 patients, SPINE, 24(12), 1999, pp. 1243-1246
Study Design. A retrospective review of 25 patients who underwent a modifie
d surgical procedure for the treatment of far lateral disc herniation.
Objectives. To describe a modification of previous surgical techniques for
the treatment of far lateral disc herniation and to review the outcomes in
resolution of pain and improvement of functional status.
Summary of Background Data. Lumbar disc herniations that occur far lateral
to the intervertebral facet result in spinal nerve compression at L3-L4 and
L4-L5. Previous surgical techniques have resulted in an increased risk of
instability or continued postoperative back pain.
Methods. Twenty-five patients with far lateral disc herniation underwent su
rgery using an extreme lateral approach. There was no medial facetectomy or
disruption of the pars interarticularis. The intertransverse ligament Was
released from the superior portion of the inferior transverse process, and
the nerve was located before removal of the disc. Preoperative and postoper
ative visual analog pain scale and Oswestry functional status evaluation we
re reviewed along with complications to evaluate the efficacy of the surger
y.
Results. No serious complications were noted, although transient neuropathi
c pain was:common and was theorized to be caused by manipulation of the dor
sal root ganglion during surgery. This pain was usually resolved within 4 t
o 6 weeks. The mean preoperative and postoperative visual analog scale scor
es were 7.7 and 4.2, respectively. The mean preoperative and postoperative
Oswestry scores were 50.7% and 34.7%, respectively. Both of these improveme
nts were statistically significant (P < 0.01).
Conclusions. This far lateral approach allowed the nerve and far lateral di
sc herniations to be easily identified. Also, there was less blood loss and
no medial facetectomy or:disruption of the pars interarticularis. This is
a safe, effective technique with no disruption of spinal stability.