J Korean Neurosurg Soc.  1995 Nov;24(11):1385-1391.

Clinical Experiences in the Treatment of Far Lateral Lumbar Disc Herni

• Nho JS
• Chung HY
• Lee U
• Kang DS
• Kim YB
• Bak KH

Abstract

The authors present 12 cases of far lateral disc herniation(FLDH) diagnosed and treated in our institution from march, 1992 to February, 1994. In the author's series the incidence of far lateral disc herniation was 5% of all lumbar disc herniations. The average age of the patients was 4 years and there were 7 men and 5 women. The L4-5 intervertebral disc level was the most commonly involved level. All patients initially presented with symptoms of radiculopathy. Cases with double herniations at the same level and on the same side seemed to have the most potential source of misdiagnosis and mismanagement, and a careful surgical consideration was needed for such cases. In 4 cases, a combined intraspinal and extraforaminal approach was performed with preservation of facet joints and in 2 cases, paramedian muscle splitting approach was performed. Chemonucleolysis and the usual partial hemilaminectomy were undertaken in 5 cases and in 1 case, respectively. The combined approaches proved to be an effective means of treatment for cases with double herniations, but misdiagnosis of such lesion can lead to an inappropriate and an ineffective treatment and poor surgical results. Furthermore, in the diagnosis of far lateral disc herniation, differentiation must be made from symptoms of conjoined nerve root and congested epidural vein.

Keyword

Combined approach; Double herniation; Far lateral disc herniation; Paramedian approach

MeSH Terms

Diagnosis
Diagnostic Errors
Estrogens, Conjugated (USP)
Female
Humans
Incidence
Intervertebral Disc
Intervertebral Disc Chemolysis
Male
Radiculopathy
Veins
Zygapophyseal Joint
Estrogens, Conjugated (USP)