Far lateral lumbar disc herniation (FLLDH) compresses the nerve root at the same level. The laterally herniated disc fragment typically could not be exposed by the standard posterior hemi-laminectomy technique, and a total facetectomy including wide bone removal is usually mandatory for good exposure and removal of the herniation but simultaneously increasing the risk of instability. In the present study, the author presents his initial 4-year experience and surgical outcome in treatment of far lateral lumbar disc herniation with a posterior endoscopic approach. This study was carried out in the period between February 2011 and January 2015, where 33 consecutive patients with symptomatic FLLDHs underwent a posterior endoscopic lateral approach for resection of the herniation. The mean age was 39.3 years, range 26–59 years. Patients were followed up for 4 years (mean follow-up was 19.9 months, range 3–47 months). Patients had their clinical outcomes reviewed and evaluated in terms of pain by visual analog scale (VAS) and in terms of functional outcome by modified Macnab criteria (MMC). Mean operative time was 91 min (range 55–166 min). At initial follow-up, according to MMC (3 months postoperative), 86% of patients were pain-free (28/33) and considered their postoperative status as excellent and 14% as good (5/33), and no patients reported a fair or poor outcome. There were no new postoperative neurological deficits or major complications. There were three cases of accidental medial facetectomy due to excess bony work, a single case of dural tear, and a single case that had a transient postoperative neuralgia that persisted for 2 weeks. FLLDH can be treated adequately with the reported microendoscopic approach. The technique is associated with marked improvement in back pain and lower limb symptoms, as well as a short length of hospitalization and other benefits of minimal invasiveness. Although a transitory learning curve is necessary, the endoscope in general was safe in handling bimanually and allowed adequate mobility and visualization.

中文翻译：

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显微内窥镜治疗远侧腰椎间盘突出症的初步研究：33例患者

远侧腰椎间盘突出症（FLLDH）在相同水平上压缩神经根。标准的后半椎椎板切除术通常无法暴露出侧突椎间盘碎片，通常要进行良好的暴露和椎间盘切除术必须进行包括宽阔骨切除在内的全小平面切除术，但同时会增加不稳定的风险。在本研究中，作者介绍了他的最初4年经验和后路内窥镜治疗远侧腰椎间盘突出症的手术效果。这项研究在2011年2月至2015年1月期间进行，其中33例有症状的FLLDH患者接受了后侧内镜下侧入路切除疝。平均年龄为39.3岁，范围为26-59岁。对患者进行了4年的随访（平均随访19.9个月，范围3–47个月）。通过视觉模拟量表（VAS）对患者的临床结局进行评估和评估，并通过改良的Macnab标准（MMC）对患者的功能结局进行评估。平均手术时间为91分钟（55-166分钟）。根据MMC（术后3个月）的初步随访，有86％的患者无痛（28/33），并且认为术后状况良好，14％良好（5/33），并且没有患者报告公正或糟糕的结果。术后无新的神经功能缺损或重大并发症。有3例因过度的骨骼工作而导致的意外内侧小平面切除术，1例硬脑膜撕裂病例和1例持续短暂的术后神经痛持续2周的病例。FLLDH可以用已报道的显微内镜方法充分治疗。该技术可显着改善背部疼痛和下肢症状，缩短住院时间，并具有微创治疗的其他优势。尽管必须要有短暂的学习曲线，但内窥镜通常可以安全地双手操作，并具有足够的移动性和可视性。