Pdf ctmr spectrum of far lateral and anterior lumbosacral. This discal pathology has been recognized for many years as an occasional cause of negative disc exploration and immediate failure of classical disc surgery in sciatica 1, 18, 24, 25, 29, 31, 30, 31, 33, 35, 41. Lateral transmuscular or combined interlaminarparaisthmic. There were 16 men and four women with a mean age of 52 years 26 to 78, and a mean duration of symptoms of 23 weeks 4 weeks to 2 years. Far lateral thoracic disc herniation presenting with flank pain. Pdf far lateral thoracic disc herniation presenting with. The microendoscopic approach for far lateral lumbar disc. The effect of facet tropism on the development of posterolateral lumbar disc herniation has been investigated previously, but there has been no study on far lateral lumbar disc herniation.
The target of the surgical exposure is the isthmus. The results were compared to show any differences between the two types of lumbar disc herniations. The optimum operative technique for lateral lumbar disc herniations lldh remains unclear, and both interlaminar and extraspinal approaches are used. Manual muscle testing could not be performed because of pain. The lateral branch of the posterior primary ramus leads to the ventral nerve root and subsequently to the lateral disc herniation fig. Kanter, md, extreme lateral, minimally invasive, transpsoas. Minimally invasive approach to far lateral lumbar disc. Ct mr spectrum of far lateral and anterior lumbosacral disk. Transforaminal percutaneous endoscopic surgery for far. Combined approach for far lateral lumbar disc herniation. Pdf lumbar discectomy is one of the most commonly performed neurosurgical procedure. Direct tubular lumbar microdiscectomy for far lateral disc.
Good knowledge of the anatomic features of the intervertebral foramen and intertransverse space is mandatory. Familiarity with atypical locations of an extraforaminal disc herniation can guide intraoperative decisionmaking. Fortyone of 50 efdhs had a coexisting intraforaminal component. Note the far lateral disc herniation with endplate hypertrophy extending into the osseoligamentous canal and lateral to the canal creating spinal stenosis. The degree of facet tropism and disc degeneration was measured at the herniated disc level by using magnetic resonance imaging. Far lateral disc herniation is also known as foraminal, intraforaminal, far lateral or extreme lateral disc herniation, which by definition refers to a disc herniation or fragment that resides beneath and lateral to the vertebral facet, and is thus hidden on conventional imaging of the spinal canal. Extraforaminal with or without foraminal disk herniation ajr. Longterm follow up of patients surgically treated by the far lateral approach for foraminal and extraforaminal lumbar disc herniations j neurosurgery spine 1999. Extraforaminal lumbar disc herniationhow to approach. Thus, an fld herniation at the l34 level contributes to l3 root. Most of the disc herniations protrude into the spinal canal, thereby resulting in transverse root compression.
The clinical data from 12 patients from 19992005 were retrospectively analyzed. An extraforaminal disc prolapse is often sequestrated, many migrate superiorly and laterally. Surgical approaches to far lateral disc herniation are challenging because of the anatomical limitations in the region. An evaluation in 60 patients of the comparative value of ct, mri, and myeloct in diagnosis and management. In the cervical and lumbar areas they are thicker anteriorty or towards the front of. Far lateral disc herniation is an infrequent cause of sciatica, accounting for 0. A 53yearold white married female is referred to me from a local chiropractor for the chief complaints of right low back pain which radiates into the right anterior thigh, stopping at the knee. The posterior annular defect from which the far lateral disc herniation emanates may occur anywhere from the midline of the disc to the extreme lateral1 region of. All patients complained of intense, unilateral radicular.
Pdf management of lumbar far lateral disc herniation. Far lateral lumbar intervertebral disk herniation fllidh most commonly occurs far lateral to the intervertebral facet at l3l4 and l4l5 and accounts for 3. What makes a far lateral disc herniation unique and. An extraforaminal disc fragment in the superolateral quadrant represents an unusual and atypical location.
The author describes patient experience using the technique he prefersa midline, muscle retracting incision, foraminotomy, and direct microsurgical visualization of the regionwhich is adaptable to a variety of herniations. A neurosurgical approach to farlateral disc herniation in. The comparisons of surgical outcomes and clinical characteristics between the far lateral lumbar disc herniations and the. Between 2000 and 2005, a total of 2035 patients with lumbar disc herniation underwent surgical discectomy by the. The results of surgical decompression via the microendoscopic far lateral approach were good in all patients with minimal discomfort. Jul 26, 2016 in a far lateral hnp, occurring only in about 10% of cases, the piece of disc herniates on the side of the spine and compresses the nerve along its course within the neural foramen as it exits the spine e. For far lateral disc herniation, the junction between the pars and the. This technique is a simple modification of the standard neurosurgical approach. Lateral disc herniation creates something of a dilemma for.
Of a total of 330 patients requiring operation on a lumbar disc, 20 6. The efficacy of transforaminal epidural steroid injection. Although l45 disc herniation is the most common lumbar pathology to cause foot drop, l5s1 disc herniation can be identified as the cause in up to 25% of cases 10. The surgical treatment of far lateral lumbar disc herniation acta. This study is designed to define clinical and epidemiological findings and to establish the indications of surgical and medical treatment for flldh. Pdf foraminal and far lateral lumbar disc herniations. Determine type of herniation, probability of contained vs. To get in and out of this position, lay on your side first, with the side that has the suspected disc bulge on it facing the sky. Extraforaminal disc herniation can be diagnosed with the aid of ct scan and mri. Five cases of far lateral lumbar disc herniations treated conservatively. Far lateral discal herniation is an uncommon disorder and is difficult to assess by physical examination alone. The minimally invasive surgical treatment via the microendoscopic far lateral.
Ct mr spectrum of far lateral and anterior lumbosacral. The laterally herniated disc fragment typically could not be exposed by the standard posterior hemilaminectomy technique. A posterolateral microsurgical approach to extremelateral lumbar. Patients with a far lateral disc herniation presented with significantly lower preoperative sf12 and vr12 scores. Upper lumbar root compression syndromes are four times more likely to be caused by farlateral disc herniations than by herniation of discs above the l45. Microendoscopic approach to farlateral lumbar disc herniation. What makes a far lateral disc herniation unique and painful. Far lateral disc herniation spine specialist vail, aspen. Several authors have reported that the majority of.
However, unlike most herniations where the same level nerve is compressed, the far lateral disc bulge compresses the root above the affected level, causing a discrepancy between the symptoms seen and the symptoms expected. Far lateral disc herniation often occurs at the l45 level. The far lateral approach is a musclesplitting approach that allows surgeons to reach the disc herniation without any facet bone removal. Example, if you suspect a disc bulge on the right side, then always roll onto your left side to get up and down. Symptomatic far lateral lumbar disc herniation is a less common causes of lumbar radiculopathy than paracentral or central disc herniation. Lumbar disc herniation arises when the annulus fibrosus of the vertebral disc fails, thus allowing displacement of the nucleus pulposus and other tissue.
Diagnosis and microsurgical approach to farlateral disc herniation. Often, disc herniations at this level are in a far lateral position that can affect the exiting l5 nerve root, with or without compression of the traversing s1 nerve root. Pain and tingling in the leg, numbness and weakness. The far lateral disc protrusion can enact pain by causing a pinched nerve. Microendoscopicdiscectomy med for far lateral disc.
Pdf far lateral disc herniations constitute 712% of all disc herniations. A technique for exposing far lateral intervertebral disc herniations without disrupting the facet is described. Surgical treatment of far lateral lumbar disc herniation. Sep 18, 2002 far lateral discs represent 712% of all lumbar disc herniations and usually involve free fragments which have migrated superolateral to the disc space of origin. Far lateral lumbar disc herniations and associated structural abnormalities. Intraforaminal and extraforaminal far lateral lumbar disc herniation. The far lateral herniated lumbar disc has become increasingly recognized as a cause for low back pain and lumbar radiculopathy as well as for failed back syndrome in certain improperly diagnosed cases. Despite the varied terminology used in published reports, such as lateral, extreme lateral, foraminal and extra. The l4 nerve root and l3 dorsal root ganglion are compromised.
A manual on autotraction treatment for low back pain. All patients had lateral herniation of disk density or signal material beyond the osseous confines of the neural foramina as demonstrated on ct or mr. Far lateral lumbar disc herniation flldh compresses the nerve root at the same level. Evaluation of varied surgical approaches used in the. Outcome assessment was performed using neurological status, the. In thickness, the discs vary in different portions of the spine. Mar 01, 2016 far lateral disc herniation is also known as foraminal, intraforaminal, far lateral or extreme lateral disc herniation, which by definition refers to a disc herniation or fragment that resides beneath and lateral to the vertebral facet, and is thus hidden on conventional imaging of the spinal canal. This concept has most likely arisen because in the midline the pll is. A disc protrusion is a herniation in which the displaced disc material is confined by the outermost annular fibers. The term far lateral is used variably in the literature and usually refers to an extraforaminal displacement in the peridiscal zone peripheral to the sagittal plane of the most lateral part of the pedicle at the same level.
Thirtyeight lumbar disc herniations far lateral, n 19. Cureus minimally invasive farlateral microdiscectomy. Far lateral lumbar disc herniation flldh compresses the nerve root or dorsal ganglion. Pdf intraforaminal and extraforaminal far lateral lumbar. In far lateral disc herniations, however, the protruded, extruded, or sequestrated discs cause foraminal stenosis, thus. The diagnosis of extreme lateral lumbar disc herniation elldh as a cause of lumbar radiculopathy was first described by abdullah in 1974. Retrospective analysis of data of all patients with flldh treated by minimally invasive discectomy. Determine likely level of herniation and which nerve roots are involved on clinical grounds. To describe our minimally invasive technique for the surgical treatment of far lateral lumbar disc herniation flldh using metrx tissue dilators system and a surgical microscope. To compare outcome after lldh removal either by a lateral transmuscular approach ltm or by a combined interlaminar and paraisthmic approach cip. Although successful visual ization of protrusions of the lateral disk, which account for 610% of all. Forty one 82% of 50 efdhs had a coexisting foraminal component while nine 18% of 50 had an isolated far lateral herniation without intraforaminal extension fig.
However, treatment of far lateral disc herniation using lateral lumbar interbody fusion llif without neural manipulation. This next diagram shows the more usual pattern of a postero lateral disc herniation, not to be confused with the the above far lateral disk protrusion. The far lateral approach to lumbar disc herniations. Several authors have reported that the majority of patients show poor response to conservative measures. Fortyeight patients had 50 extraforaminal disk herniations efdhs demonstrated on ct andor mr by 1 presence of disk density or disk signal material lateral to the neural foramen, 2 displacement or obliteration of paravertebral fat, and 3 nerve root or ganglion compression or displacement. Far lateral disc herniation occurs with a frequency between 0. Figure 2 some authors will use the posterior longitudinal ligament pll as a measure of the outer confines of the disc. The laterally herniated disc fragment typically could not be exposed by the standard posterior hemilaminectomy technique, and a total facetectomy including wide bone removal is usually mandatory for good exposure and removal of the herniation but simultaneously increasing the risk of instability. Jan 01, 1993 far lateral lumbar disc herniations are among several types of cephalad migrated disc herniations.
The prone position may be done for a few days before attempting the next part. Laserassisted microdiscectomy for far lateral lumbar disc. In far lateral disc herniations, however, the protruded, extruded, or sequestrated discs cause foraminal stenosis, thus leading to compression of the root and symptoms associated with the root. Atypical anatomy associated with a lumbar far lateral disc. Paraspinal approach to the far lateral disc herniations. Far lateral lumbar intervertebral disk herniation fllidh is a wellrecognized clinical and. Minimally invasive surgery introduction far lateral disc herniation is an infrequent cause of sciatica, accounting for 0. I created this video with the youtube video editor.
The term far lateral is often used to describe a lumbar disc herniation that. To discuss the characteristics and management of far lateral lumbar disc herniation. Lateral herniation of a lumbar disc extending into or beyond the. However, hood reported that far lateral lumbar disc herniation. Cureus farlateral disc herniation treated by lateral. Laserassisted microdiscectomy for far lateral lumbar disc herniation at the l5s1 level. Despite the varied terminology used in published reports, such as lateral, extreme lateral, foraminal and extraforaminal, this clinical entity is characterized by the development of disc herniation lateral to the more commonly encountered posterolateral. They may be purely far lateral or extraforaminal in location, located. Jun 01, 2017 far lateral disc herniations are commonly found in the inferomedial location. The improvement in odi score from preoperative to final was significantly lower in the patients presenting with a far lateral hnp.
There was complete resolution of leg pain presented. Treatment of far lateral disc herniation with a retroperitoneal, transpsoas approach and disc fragment excision has been described. Pdf on jul 28, 2020, mudit mathur and others published lumbar disc herniation. Pdf surgical treatment of far lateral lumbar disc herniation. Management of far lateral lumbar disc herniations clinical gate. Prognosis for recovery of foot drop after transforaminal. The efficacy of transforaminal epidural steroid injection by.
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