title: Ultra-long-term outcome of surgically treated far-lateral, extraforaminal lumbar disc herniations: a single-center series.
abstract: OBJECTIVE
  Far-lateral extraforaminal lumbar disc herniation is an uncommon cause of nerve root entrapment, and studies addressing the long-term outcome of surgically treated patients are few. The purpose of this study was to analyze the ultra-long-term outcome of patients who were treated via a lateral approach.
  
  
  METHODS
  The medical reports of 138 consecutive patients were analyzed with regard to signs and symptoms, operative findings, complications, and short-term outcome (6 weeks). To assess long-term results, standardized telephone interviews were performed using a structured questionnaire. The patients were questioned about pain using the verbal rating scale and persisting symptoms, if any. Other queries were related to the Oswestry Disability Index. Subjective satisfaction with the result of surgery was classified as excellent (no pain), good (some pain), fair (moderate pain), and poor (unchanged or worse) based on MacNab classification.
  
  
  RESULTS
  At short-term follow-up, major and moderate leg pain had decreased from 99.3 to 5.1% and low back pain from 97.8 to 2.8%. Sensory and motor deficits, however, were still present in the majority of patients. A total of 87 telephone interviews were conducted, and the mean follow-up was 146 months. As many as 49 patients (56.3%) reported complete relief of symptoms, 14 patients (16.1%) had minor ailments under physical stress, and 24 patients (27.6%) had permanent residual symptoms. The most common complaint was remaining sensory disturbance. Despite residual symptoms, the vast majority of patients expressed satisfaction with the result of surgery. The outcome was subjectively rated as follows: 75.9% excellent (66 patients), 18.4% good (16 patients), 4.6% fair (4 patients), and 1.1% poor (1 patient).
  
  
  CONCLUSIONS
  The lateral approach is a minimally invasive and safe procedure with low complication rates. The profit from surgery is maintained beyond the usual postoperative observation periods. Thus, ultimate outcome at ultra-long-term follow-up is very gratifying in the vast majority of patients.
authors.affiliation: Neurosurgical Clinic, Johann Wolfgang Goethe-University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany. G.Marquardt@em.uni-frankfurt.de
authors.forename: Gerhard
authors.initials: G
authors.lastname: Marquardt
authors.forename: Markus
authors.initials: M
authors.lastname: Bruder
authors.forename: Stephanie
authors.initials: S
authors.lastname: Theuss
authors.forename: Matthias
authors.initials: M
authors.lastname: Setzer
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000453:epidemiology; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000473:pathology* / Q000601:surgery*; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D017060:Patient Satisfaction; D015995:Prevalence; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome