Five cases of far lateral lumbar disc herniations treated conservatively

Abstract Far lateral lumbar disc herniation (FLLDH) compresses the nerve root or dorsal ganglion outside the spinal canal at the same level of the herniation and produces severe pain on the anterolateral thigh. Computed tomography or magnetic resonance imaging (MRI) allow successful diagnosis of FLLDH, though one-third of FLLDH is still overlooked at the initial examination. There have been few reports about conservative therapies for FLLDH. We describe five cases of FLLDH treated recently with success using several kinds of nerve blocks. All the cases complained of severe pain at the gruteal or anterolateral part of lower extremity and four of them could not walk because of pain. The axial view of MRI was useful for the diagnosis of FLLDH. Neither lumbar epidural block nor the root block were effective for pain reduction. However, puncturing of herniated mass using a block needle, and a subsequent interdiscal injection of a steroid and a local anesthetic decreased pain in all cases. FLLDH should be taken...