Surgical treatment for the far lateral herniated lumbar disc.

Twenty-nine patients underwent surgery for far lateral herniated nucleus pulposus. Average patient age was 65 years in the 14 male and 15 female patients involved. The L4-5 disc was the most commonly herniated level (59%) followed by L3-4 (31%), L5-S1 (7%), and L2-3 (3%). All patients were initially seen with radiculopathy and 23 patients (79%) had motor weakness. A pars interarticularis sparing technique is described for approaching this type of disc herniation. This approach allows direct visualization of the disc and involved root. The results are encouraging with 72% of patients having good or excellent relief of pain. Seventy-one percent of those with preoperative weakness had no weakness or improvement in strength postoperatively. In general, far lateral herniated nucleus pulposus occurs in older patients and at high lumbar disc levels. Postoperative results are similar to the more common posterolateral herniated nucleus pulposus in patients of the same age group. A surgical approach is described to better address the less familiar anatomy.