Intractable radiculopathy resistant to conservative measures

Unilateral, single-level, nerve root compression lateral to the neuroforamen

Far lateral disk herniation confirmed by computed tomography (CT) scan or magnetic resonance imaging (MRI): nucleus pulposus herniates beyond the intervertebral foramen, or at least two-thirds lateral to the vertebral pedicle (Papavero and Caspar, 1993).

Absence of segmental instability, facet incompetence, or additional pathologies, that is, spinal stenosis or associated central disk herniation

Radiculopathy correlating with radiographic evidence of far lateral disk herniation (FLDH) compressing the symptomatic exiting nerve root

Presentation

Physical examination

Imaging

Anatomic definition: Far lateral, extraforaminal, or extreme lateral disk herniation denotes a disk hernia occurring lateral to the neuroforamen and the facet joint complex (Figure 26-2). The herniated disk fragment usually compresses the exiting nerve root and displaces it superiorly and laterally under tension.

Because of its anatomic location (Figure 26-3, A), unlike the posterolateral herniated nucleus pulposus (HNP), which affects the traversing nerve root (Figure 26-3, B), FLDH affects the exiting nerve root at the same level.

The anatomic boundaries of the “operative window” or “surgical corridor” for the intertransverse lateral approach (Figure 26-4) are

The prone position with abdomen free hanging is preferred by most surgeons.

Although both regional and general anesthesia have been described (Reulen et al, 1996), general anesthesia with endotracheal intubation offers more control of the airway and is preferred by the authors.