title: The surgical treatment of far lateral L3-L4 and L4-L5 disc herniations. A modified technique and outcomes analysis of 25 patients.
abstract: METHODS
  A retrospective review of 25 patients who underwent a modified surgical procedure for the treatment of far lateral disc herniation.
  
  
  OBJECTIVE
  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.
  
  
  BACKGROUND
  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 surgery 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 postoperative visual analog pain scale and Oswestry functional status evaluation were reviewed along with complications to evaluate the efficacy of the surgery.
  
  
  RESULTS
  No serious complications were noted, although transient neuropathic pain was common and was theorized to be caused by manipulation of the dorsal root ganglion during surgery. This pain was usually resolved within 4 to 6 weeks. The mean preoperative and postoperative visual analog scale scores were 7.7 and 4.2, respectively. The mean preoperative and postoperative Oswestry scores were 50.7% and 34.7%, respectively. Both of these improvements were statistically significant (P < 0.01).
  
  
  CONCLUSIONS
  This far lateral approach allowed the nerve and far lateral disc 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.
authors.affiliation: Chattanooga Orthopaedic Group, Foundation for Research, Tennessee, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Hodges
authors.forename: S C
authors.initials: SC
authors.lastname: Humphreys
authors.forename: J C
authors.initials: JC
authors.lastname: Eck
authors.forename: L A
authors.initials: LA
authors.lastname: Covington
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000503:physiopathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome