Background: Rarely can a herniated disc in the far-lateral extraforaminal area of the lumbar spine cause compression of a nerve root.
Objective: To focus on L5-S1 foraminal/extraforaminal lumbar disc as well as to analyze the outcome of surgical management via the lateral approach.
Patients and Methods: From March 2016 to July 2020, 42 patients with L5-S1 foraminal or extraforaminal disc herniations were included in this study after they received unilateral L5-S1 paraspinal decompression at Benha University Hospitals and Brüder Hospital Trier. All medical charts of the included patients were reviewed and analyzed regarding clinical presentation, complete neurological examination, operative findings, complications, and short-term outcome. MacNab scale of excellent (no pain), good (some pain), fair (moderate pain), and poor was used to assess patients' subjective levels of postoperative satisfaction (unchanged or worse).
Results: Preoperative sensory and motor deficits showed obvious improvement in the majority of patients. Motor weakness showed significant improvement in 24 patients out of 30 patients (80%). Pain scoring (Visual Analogue Score; VAS) after surgery before discharge of the patients from the hospital revealed that 23 patients had no pain, 16 patients had mild to moderate pain (VAS 1-3) and 3 patients had significant pain (VAS >4).
Conclusions: Orientation of the pathology, proper diagnostic imaging as well as familiarity of the approach are significant factors for patient’s improvement. We have found that our modified lateral approach is a safe, minimally invasive option with little complications