Abstract
Various techniques for the surgical treatment of far lateral lumbar disc herniation (FLLDH) have been reported. However, these invasive techniques incur various bony and soft tissue damage. We report the cases of 2 patients who underwent microendoscopic discectomy for FLLDH by a newly modified minimally invasive technique. Two male patients, aged 56 and 25 years, had FLLDH. Indications for surgery included radiculopathy that failed to respond to conservative treatment. Both patients completed the Japan Orthopaedic Association (JOA) instrument for scoring low back pain, before and after surgery. The extraforaminal triangle approach (EFTA) to the affected intervertebral disc was used with a limited release of the inferior-medial portion of the intertransverse ligament. This release provided adequate exposure of the herniated disc and exiting nerve root. The operation time of each case was 140 minutes, intraoperative blood loss was 56 ml or less than five ml. The hospital stays were 9 days and 16 days, respectively. The improvement of JOA scores were 81% and 89%, respectively, at one month after surgery. In both cases, there was minimal blood loss, no medial facetectomy or disruption of the pars interarticularis. The EFTA required less dissection and manipulation of nerve structures than other techniques, and is, therefore, a safer and less invasive surgical management for the treatment of FLLDH.
