• ChauAnthony Minh TienAMTBrisbane Clinical Neuroscience Centre, Mater Hospital, South Brisbane, QLD, Australia., Aaron Lerch, Barton Waser, Lauren Green, Jason Papacostas, Antonio Tsahtsarlis, Jason McMillen, Robert Campbell, Martin Wood, and Damian Amato.
• Brisbane Clinical Neuroscience Centre, Mater Hospital, South Brisbane, QLD, Australia.
• Eur Spine J. 2024 Nov 1; 33 (11): 438543914385-4391.

BackgroundFar lateral (extraforaminal) disc herniations comprise approximately 10% of symptomatic lumbar disc herniations. They represent operative challenges due to accessibility and surgical unfamiliarity. Surgical strategies in the past have included open discectomy and posterior lumbar interbody fusion. Tubular microdiscectomies have gained traction due to their minimally invasive advantages, including reduced morbidity, pain and length of hospital stay.MethodsWe report our retrospective single institution consecutive case series of tubular far lateral microdiscectomies. One hundred and seventy-six patients were operated on over an eight-year period. Clinical outcomes were assessed after institutional ethics approval. We additionally describe our surgical technique with an illustrative video case.ResultsOver a mean follow-up of 21 weeks, 77% of patients had good or excellent clinical outcomes according to the MacNab criteria. 12% of patients underwent reoperation at the index level for symptom recurrence or persistence. Mean length of hospital stay was 1.3 days. There was a 1% rate of both postoperative haematoma and infection. Mean operation duration was 86 minutes.ConclusionThis case series represents the largest currently reported in the literature. Minimally invasive microdiscectomies performed through tubes allow for precise localisation, reduced tissue disruption and favourable clinical outcomes. Our results appear consistent with a review of the literature, demonstrating the safety and efficacy of this approach.© 2024. The Author(s).

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