5. Foraminal and Extraforaminal Disc Herniations
@ProfFishchenkoForaminal and extraforaminal lumbar disc herniations account for approximately 7–12% of all lumbar disc herniations and occur more frequently in older patients.
Depending on the location of the herniation, compression of the exiting nerve root occurs within the intervertebral foramen or outside it. Radicular pain at this location may be particularly severe because of irritation and compression of the nerve root and dorsal root ganglion.
In the surgical treatment of these herniations, a posterolateral approach allows targeted decompression of the exiting nerve root and discectomy using BESS/UBE. We select the specific approach trajectory according to the location of the herniation and the anatomy of the intervertebral foramen.
References
1. Park HW, Park KS, Park MS, Kim SM, Chung SY, Lee DS. The comparisons of surgical outcomes and clinical characteristics between the far lateral lumbar disc herniations and the paramedian lumbar disc herniations. Korean J Spine. 2013;10(3):155–159. doi:10.14245/kjs.2013.10.3.155.
2. Costa F, Oertel J, Zileli M, et al. Role of surgery in primary lumbar disk herniation: WFNS Spine Committee recommendations. World Neurosurg X. 2024;22:100276. doi:10.1016/j.wnsx.2024.100276.
3. Choi DJ, Kim JE, Jung JT, et al. Biportal endoscopic spine surgery for various foraminal lesions at the lumbosacral lesion. Asian Spine J. 2018;12(3):569–573. doi:10.4184/asj.2018.12.3.569.
4. Ahn JS, Lee HJ, Choi DJ, Lee KY, Hwang SJ. Extraforaminal approach of biportal endoscopic spinal surgery: a new endoscopic technique for transforaminal decompression and discectomy. J Neurosurg Spine. 2018;28(5):492–498. doi:10.3171/2017.8.SPINE17771.
5. Park JH, Jung JT, Lee SJ. How I do it: L5/S1 foraminal stenosis and far-lateral lumbar disc herniation with unilateral bi-portal endoscopy. Acta Neurochir (Wien). 2018;160(10):1899–1903. doi:10.1007/s00701-018-3630-9.
Previous section: 4.14. Clinical Examples (Videos with Commentary)
Next section: Indications and Contraindications