Is a far lateral lumbar microdiscectomy an effective approach for far lateral herniations?

Abstract

Far lateral disc herniations (FLDH) comprise only 7% of lumbar disc herniations, however patients experience excruciating radicular pain due to the compression of the dorsal root ganglion as well as the exiting nerve root. Additionally, surgical treatment of FLDHs is much more challenging in comparison to the more common posterolateral herniations, due to inherent difficulties in accessing the far lateral compartment. Numerous surgical approaches have been described and investigated in the literature all aiming to balance out the need for adequate exposure while avoiding compromise of spinal stability. Many of these utilise the common midline approach that most surgeons are familiar with. Key findings: FLMD via the Wiltse technique for lumbar FLDH is a suitable surgical technique that allows more direct exposure to the disc pathology and provides acceptable patient outcomes. There was a significant improvement in PROMs (VAS score for back pain and leg pain, ODI, SF-12 mental and physical components) for patients undergoing this procedure.