Minimally Invasive, Far Lateral Lumbar Microdiscectomy with Intraoperative Computed Tomography Navigational Assistance and Electrophysiological Monitoring.

Abstract

Patients with far lateral disc herniation (FLDH) experience more severe pain and sensory symptoms compared with those with paracentral disc herniation. In addition, surgical intervention has both been more challenging and resulted in poorer outcomes. We report our experience with intraoperative computed tomography (iCT) navigation-assisted minimally invasive tubular microdiscectomy via a paramedian approach with electrophysiological monitoring for precise 3-dimensional anatomical localization and early electrophysiological identification of the exiting nerve. Five patients presenting with weakness and pain refractory to conservative management underwent iCT navigation surgery for lumbar FLDH with electrophysiological monitoring. The mean decrease in the visual analog scale pain score was -7.1 and the modified MacNab criteria outcomes were good in 1 patient and excellent in 4 patients. These results from a small group of patients suggest this is a safe approach with the potential for improved outcomes in the surgical treatment of FLDH.