Minimally Invasive Approach for Far Lateral Disc Herniations: Results from 20 Patients

BACKGROUND: Far lateral lumbar disc herniations, while infrequent, are a substantial cause of morbidity causing painful radicular syndromes often accompanied by a motor or sensory deficit. Surgical treatment can be challenging technically because of unfamiliar lateral anatomy and the importance of adjacent osseous structures, notably the pars interarticularis and facet joint. METHOD: The traditional approach for a far lateral lumbar disc herniation involves a midline incision, wide lateral subperiosteal exposure and partial removal of these structures with the potential for iatrogenic instability. A paramedian approach to the lateral compartment of the disc space is advantageous because it directly targets the pathology. The use of recently developed minimally invasive retractor systems decreases tissue dissection and blood loss and improves postoperative recovery. RESULTS AND DISCUSSION: We present a series of 20 patients who underwent far lateral discectomy using a minimally invasive muscle splitting approach.