title: Clinical efficacy of three different minimally invasive procedures for far lateral lumbar disc herniation.
abstract: BACKGROUND
  Far lateral lumbar disc herniation (FLLDH) accounts for 2.6% to 11.7% of all lumbar herniated discs. Numerous surgical approaches have been described for treating this condition. The purpose of this study was to evaluate minimally invasive surgical techniques for the treatment of FLLDH.
  
  
  METHODS
  From June 2000 to March 2006, 52 patients with FLLDH were treated with minimally invasive procedures. All patients were assessed by anteroposterior and lateral roentgenography and computed tomography (CT). Some patients underwent myelography, discography, and magnetic resonance imaging. Procedures performed included Yeung Endoscopy Spine System (YESS) (n = 25), METRx MicroDiscectomy System (n = 13), and X-tube (n = 14). Patients were followed up for a mean of 13.5 months. Clinical outcomes were assessed using a visual analog scale (VAS) and Nakai criteria.
  
  
  RESULTS
  All 3 procedures significantly improved radiating leg symptoms (P < 0.005). After surgery, 84.0%, 84.6%, and 92.8% of patients in the YESS, METRx, and X-tube groups had excellent or good outcomes. There were no statistically significant differences of VAS scores between the groups. The YESS procedure was associated with the shortest operation time, simplest anesthesia, and least trauma compared with the other 2 procedures, especially for type I herniations. The METRx procedure was the most suitable for type II herniations and posterior endoscopic facetectomy. Posterior lumbar interbody fusion and unilateral pedicle screw instrumentation with X-tube was the most suitable for herniations combined with degenerative lumbar instability (type III).
  
  
  CONCLUSIONS
  Minimally invasive strategies and options should be determined with reference to the type of FLLDH.
authors.affiliation: Department of Orthopaedics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Liu
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhou
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.forename: Tong-wei
authors.initials: TW
authors.lastname: Chu
authors.forename: Chang-qing
authors.initials: CQ
authors.lastname: Li
authors.forename: Zheng-feng
authors.initials: ZF
authors.lastname: Zhang
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.forename: Wen-jie
authors.initials: WJ
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*