True far lateral (extraforaminal) lumbar disc herniations are not rare. Diagnosis can be strongly suspected when high or mid-lumbar radiculopathies present clinically; diagnosis can be confirmed by computerized tomography and/or magnetic resonance imaging. When operative treatment is required, the off-midline paramedian exposure with little or no bone removal is the indicated procedure, produces little morbidity, and causes practically no low back disability.
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Faust et al. (1992) studied this question.