121 Far Lateral Discectomy
Michael W. Groff

♦ Preoperative

• Magnetic resonance scan of lumbosacral without contrast
  
• Myelography is of limited use because the nerve root sleeve ends at the foramen.
  
• Please see Chapter 120, Lumbar Discectomy

Special Equipment

• Basic spine tray
  
• Kerrison rongeurs
  
• High-speed drill with “match-head” bit
  
• Deep retractors: tubular, anterior cervical discectomy and fusion style, or deep cerebellar retractors

Anatomy and Nomenclature

• Nomenclature of far lateral discs has been inconsistent and confusing
  
• A far lateral disc is one that is primarily lateral to the neural foramen

Operating Room Set-up and Anesthetic Issues

• Same as lumbar discectomy (see Chapter 120, Lumbar Discectomy)

♦ Intraoperative (Fig. 121.1)

Positioning

• Same as lumbar discectomy (see Chapter 120, Lumbar Discectomy)

Mark Incision

• The incision is centered on the disc space and is 3 cm in length.
  
• Fluoroscopy is useful in designing the incision.

Sterile Scrub and Prep

• Same as lumbar discectomy (see Chapter 120, Lumbar Discectomy)

Fig. 121.1 Schematic of far lateral discectomy illustrating (A) exposure, (B) bone removal, and (C) herniated disc resection.

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