Micro-endoscopic-discectomy (MED) for far lateral disc herniation in the lumbar spine. Technical note

  • P. Cervellini
  • G. P. De Luca
  • M. Mazzetto
  • F. Colombo
Part of the Acta Neurochirurgica book series (NEUROCHIRURGICA, volume 97)


This study describes a new experience of the authors in the treatment of extraforaminal disc herniation via the micro-endoscopic far lateral approach to establish a less traumatic approach to extraforaminal disc herniation with less stay in hospital and less cost. Seventeen patients who underwent surgery for extraforaminal disc herniation were analysed and long-term follow up was done revisiting all of them in hospital. The results of surgical decompression via the micro-endoscopic far lateral approach were good in all patients with minimal discomfort. There was complete resolution ofleg pain presented. Dysesthesia subsided after 2–3 weeks. Extraforaminal disc herniation can be diagnosed with the aid of CT scan and MRI. The minimally invasive surgical treatment via the micro-endoscopic far lateral approach, in our initial experience, has a high rate of succes.


Lateral disc herniation paramedian approach dis-cectomy micro-endoscopic approach 


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  1. 1.
    Abdullah AF, Ditto EW II, Bird EB et al (1974) Extreme-lateral lumbar disc herniations. Clinical syndrome and special problems of diagnosis. J Neurosurg 41: 229–234Google Scholar
  2. 2.
    Abdullah AF, Wolber PGH, Warfield JR et al (1988) Surgical management of extreme lateral lumbar disc herniations: review of l38 cases. Neurosurgery 22: 648–653PubMedGoogle Scholar
  3. 3.
    Angtuaco EJC, Holder JC, Boop WC et al (1984) Computed tomographic discography in the evaluation of extreme lateral disc herniation. Neurosurgery 14: 350–352PubMedGoogle Scholar
  4. 4.
    Brayda-Bruno M, Cervellini P, Cinnella P, Forni C, Lepori P: Micro endoscopic posterior lumbar discectomy (MED) (1999) Indication and preliminary clinical results of the Italian Multi-center Group trialGoogle Scholar
  5. 5.
    Brown LJ (1987) Definitive diagnosis of extreme lateral lumbar disc herniation. Surg Neurol 27: 373–376PubMedGoogle Scholar
  6. 6.
    Darden BV II, Wade JF, Alexander R et al (1995) Far lateral disc herniations treated by microscopic fragment excision. Techniques and results. Spine 20: 1500–1515Google Scholar
  7. 7.
    De Jesus O (1996) Diagnosis and treatment of extreme lateral lumbar disc herniation. Bol Asoc Med P R 88(7–9): 63–65PubMedGoogle Scholar
  8. 8.
    Donaldson WF 3rd, Star MJ, Thorne RP (1993) Surgical treatment for the far lateral herniated lumbar disc. Spine Aug 18(10): 1263–1267Google Scholar
  9. 9.
    Epstein NE (1995) Evaluation of varied surgical approaches used in the management of 170 far lateral lumbar disc herniations: indications and results. J Neurosurg 83: 648–656PubMedGoogle Scholar
  10. 10.
    Foley K, Smith M (1997) Micro endoscopic discectomy (MED): surgical technique and initial clinical results. Presented at the North American Spine Society 12th Annual Meeting, New York City, N.Y.Google Scholar
  11. 11.
    Gioia G, Mandelli D, Capaccioni B, Randelli F, Tessari L (1999) Surgical treatment of far lateral lumbar disc herniation. Identification of compressed root and discectomy by lateral approach. Spine 15; 24(18): 1952–1957Google Scholar
  12. 12.
    Godersky JC, Erickson DL, Seljeskog EL (1984) Extreme lateral disc herniation: Diagnosis by computed tomographic scanning. Neurosurgery 14: 549–552PubMedGoogle Scholar
  13. 13.
    Hodges SD, Humphreys SC, Eck JC, Covington LA (1999) The surgical treatment of far lateral L3–L4 and L4–L5 disc herniations. A modified technique and outcomes analysis of 25 patients. Spine 15; 24(12): 1243–1246Google Scholar
  14. Jackson RP, Glah JJ (1987) Foraminal and extraforaminal lumbar disc herniation: diagnosis and treatment. Spine 12: 577–485PubMedGoogle Scholar
  15. 15.
    Kahanovitz N, Viola K, Goldstein T, Dawson E (1990) A multicenter analysis of percutaneous discectomy. Spine 15: 713PubMedGoogle Scholar
  16. 16.
    Kornberg M (1987) Extreme lateral lumbar disc herniations: clinical syndrome and computed tomography recognition. Spine 12: 586–589PubMedGoogle Scholar
  17. 17.
    Kunogi J, Hasue M (1991) Diagnosis and operative treatment of intraforaminal nerve root compression. Spine 16: 1312–1320PubMedGoogle Scholar
  18. 18.
    Kurobane Y, Takahashi T, Tajima T et al (1986) Extraforaminal disc herniation. Spine 11: 260–268PubMedGoogle Scholar
  19. 19.
    Lew SM, Mehalic TF, Fagone KL (2001) Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations. J Neurosurg Spine (2) 94: 216–220Google Scholar
  20. 20.
    Maroon JC, Kopitnik TA, Schulhof LA, Abla A, Wilberger JE (1990) Diagnosis and microsurgical approach to far lateral disc herniation in the lumbar spine. J Neurosurg 72: 378–382PubMedGoogle Scholar
  21. 21.
    Mc Culloch JA (1989) Microsurgical approach to the lateral zone. In: Mc Culloch JA (ed) Principles of microsurgery for lumbar disc disease. Raven Press, New York, pp 239–255Google Scholar
  22. 22.
    O’Brien MF, Peterson D, Crockard HA (1995) A posterolateral microsurgical approach to extreme-lateral lumbar disc herniation. J Neurosurg 83(4): 636–640PubMedGoogle Scholar
  23. 23.
    Oeckler R, Hamburger C, Schmiedek P, Haberl H (1992) Surgical observations in extremely lateral lumbar disc herniation. Neurosurg Rev 15(4): 255–258PubMedGoogle Scholar
  24. 24.
    Pointillart V, Broc G, Senegas J (1997) A novel paraspinal approach for lumbar lateral extraforaminal root entrapment. Eur Spine J 6(2): 102–105PubMedGoogle Scholar
  25. 25.
    Segnarbieux F, Van de Kelft E, Candon E, Bitoun J, Frerebeau P (1994) Disco computed tomography in extraforaminal and foraminal lumbar disc herniation: influence on surgical approaches. Neurosurgery 34(4): 643–647, discussion 648PubMedGoogle Scholar
  26. 26.
    Shao KN, Chen SS, Yen YS, Jen SL, Lee LS (2000) Far lateral lumbar disc herniation. Zhonghua Yi Xue Za Zhi (Taipei) May 63(5): 391–398Google Scholar
  27. 27.
    Siebner HR, Faulhauer K (1990) Frequency and specific surgical management of far lateral lumbar disc herniations. Acta Neurochir (Wien) 105(3–4): 124–131Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • P. Cervellini
    • 1
  • G. P. De Luca
    • 1
  • M. Mazzetto
    • 1
  • F. Colombo
    • 1
  1. 1.Department of NeurosurgeryVicenza HospitalVicenzaItaly

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