Surgical treatment of far lateral lumbar disc herniation - Identification of compressed root and discectomy by lateral approach

Study Design. A new method is described of compressed root identification and discectomy for extraforaminal disc herniation, by a lateral intertransversalis approach. Objectives. To describe a safe surgical approach that does not require resection of adjacent bone structures during extraforaminal discectomy. Summary of Background Data. Most earlier series have reported approaches that damaged bordering bone structures with wide laminoarthrectomy. This is an attempt at a safer, simpler surgical approach. Methods. Thirteen patients with lateral hernia have undergone this surgical procedure since 1995. Herniectomy was performed after identification of the compressed root within the iliopsoas muscle. Results. All the patients resumed the upright position with the aid of a semirigid brace 24 hours after surgery. Upon awakening from the anesthesia, no patient reported peripheral pain. Motor deficits resolved after physical rehabilitation in all but one patient. At a mean follow-up of 14 months, there was no report of back pain. Conclusion. The procedure described in this article offers a simple alternative to the valid procedures presently at hand. It offers the advantage of no bone resection and of minimizing nerve structures manipulation.