Diagnosis and Surgical Treatment of Extreme Lateral Lumbar Disc herniation

Extreme lumbar disc herniation (ELLDH) is one of the diagnotic difficulties of nerve root impingement in the hidden zone. We have surgically treated thirteen patients with ELLDH, and report on their diagnosis and the surgical approach used.Subjects comprised 13 patients, (11 male, 2 female) ranging in age at surgery from 25 to 68 years (mean 46.3 years). The locations of disc hernia were intraforaminal (IF, 7 cases), and extraforaminal (EF, 6 cases).Myelography was of no value in the diagnosis of EF but implied the level of the herniated disc in IF. Discography and radiculography were more valuable for diagnotic establishment of IF. Cross sections of CTM and MRI supplied very important findings of EF. Regarding surgical procedure, the cases of IF were treated by unroofing (six cases) and hemilaminectomy (one cases), three cases of EF have been recently treated by osteoplastic hemilaminectomy without fusion instead of facet destructive procedure which was used earlier.Accuracy of preoperactive diagnosis and appropriate selection of surgical approach are needed for ELLDH.