Ümit KOCAMAN, Durmuş Oğuz KARAKOYUN, Emre ÇAVUŞOĞLU
Journal of Turkish Spinal Surgery - 2026;37(1):36-41
Objective: Far lateral lumbar disc herniation (FLLH) is a rare entity (about 7-12% of lumbar disc herniations) but causes severe radicular pain. Traditional midline approaches to FLLH frequently require facet resection, which increases the risk of postoperative segmental instability. A paraspinal (Wiltse) approach offers an alternative corridor that may preserve posterior elements.This study aimed to evaluate a modified paramedian approach for FLLH that avoids resection of any facet or pars. Materials and Methods: Fourteen patients with single-level FLLH at L2-L5 (L5-S1 excluded) were retrospectively reviewed. All patients underwent microsurgical fragmentectomy via the paramedian intermuscular (Wiltse) approach without bone removal. Leg and back pain were assessed using the visual analog scale (VAS) preoperatively and on postoperative day 10. Preoperative motor deficit, early motor recovery, neuropathic complaints, and perioperative complications were recorded. Results: Severe radicular leg pain was the chief complaint in all patients and resolved by postoperative day 10. The mean leg pain VAS score decreased from 9.0 to 0.7 (92% reduction; p<0.001). The mean back pain VAS score decreased from 3.0 to 1.5, representing a 52% reduction (p=0.002). Six patients (42.9%) had preoperative motor weakness; by day 10, three (50%) regained full strength and three (50%) regained nearly full strength. Four patients (28.6%) developed transient postoperative dermatomal paresthesia, which resolved with conservative management. No major complications occurred, and there were no early clinical signs of instability. Conclusion: The modified paramedian approach provided safe and effective decompression for FLLH without any facet or pars removal. Early outcomes showed marked pain relief and neurological recovery, supporting this stability-preserving "zero bone resection" technique as a viable option.
