Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine

摘要: Lumbar-disc herniations that occur beneath or far lateral to the intervertebral facet joint are increasingly recognized as a cause of spinal nerve root compression syndromes at upper lumbar levels. Failure diagnose and precisely localize these can lead unsuccessful surgical exploration incorrect interspace. If diagnosed, they often cannot be adequately exposed through typical midline hemilaminectomy approach. Many authors have advocated partial complete unilateral facetectomy expose herniations, which vertebral instability contribute continued postoperative back pain. The present series 25 patients who were diagnosed having disc underwent paramedian microsurgical lumbar-disc excision. Twelve L4-5 level, six L5-S1 seven L3-4 level. In cases, myelography is uniformly normal high-quality magnetic resonance images may not helpful. High-resolution computerized tomography (CT) appears best study, but even this negative unless enhanced by performing CT-discography. Discography with CT ideally suited far-lateral herniations. muscle splitting approach was found most direct favorable anatomical route neural foramen. With approach, there no destruction pain minimal. Patients typically discharged on 3rd 4th day. clinical radiographic characteristics reviewed discussed.