Berra LV, Di Rita A, Longhitano F, Mailland E, Reganati P, Frati A, Santoro A. Far lateral lumbar disc herniation part 1: Imaging, neurophysiology and clinical features. World J Orthop 2021; 12(12): 961-969 [PMID: 35036338 DOI: 10.5312/wjo.v12.i12.961]
Corresponding Author of This Article
Luigi Valentino Berra, MD, Assistant Professor, Neurosurgeon, Department of Neurosurgery, Policlinico Umberto I - Sapienza Università di Roma, No. 155 Viale del Policlinico, Roma 00161, Italy. luigivbe@tin.it
Research Domain of This Article
Orthopedics
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Dec 18, 2021; 12(12): 961-969 Published online Dec 18, 2021. doi: 10.5312/wjo.v12.i12.961
Far lateral lumbar disc herniation part 1: Imaging, neurophysiology and clinical features
Luigi Valentino Berra, Andrea Di Rita, Federico Longhitano, Enrico Mailland, Paolo Reganati, Alessandro Frati, Antonio Santoro
Luigi Valentino Berra, Department of Neurosurgery, Policlinico Umberto I - Sapienza Università di Roma, Roma 00161, Italy
Andrea Di Rita, Federico Longhitano, Department of Neurosurgery, San Carlo Borromeo Hospital, Milano 20153, Italy
Enrico Mailland, Department of Neurology, San Carlo Borromeo Hospital, Milano 20153, Italy
Paolo Reganati, Department of Neuroradiology, Manzoni Hospital, Lecco 23900, Italy
Alessandro Frati, Neurosurgery Division Human Neurosciences Department, Sapienza University, Roma 00135, Italy andDepartment of Neurosurgery, IRCCS Neuromed, Pozzilli IS 86077, Italy
Antonio Santoro, Department of Human Neurosciences, Sapienza Università di Roma, Roma 00161, Italy
Author contributions: Berra LV and Di Rita A designed and coordinated the present study, equally contributed to the work; Reganati P wrote part of the manuscript (radiological chapter); Mailland E wrote part of the manuscript (neurophysiology); Longhitano F and Frati A did literature research and wrote the manuscript; Santoro A supervised the work; All authors have read and approve the final manuscript.
Conflict-of-interest statement: No Author has any conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luigi Valentino Berra, MD, Assistant Professor, Neurosurgeon, Department of Neurosurgery, Policlinico Umberto I - Sapienza Università di Roma, No. 155 Viale del Policlinico, Roma 00161, Italy. luigivbe@tin.it
Received: January 29, 2021 Peer-review started: January 30, 2021 First decision: October 17, 2021 Revised: November 3, 2021 Accepted: December 9, 2021 Article in press: December 9, 2021 Published online: December 18, 2021
Abstract
Far lateral lumbar disc herniations (FLLDH) represent a separate category of disc pathology which includes both intraforaminal and extraforaminal lumbar disc herniations, that are characterized by a peculiar clinical presentation, diagnostic and treatment modalities as compared to the more frequent median and paramedian disc hernias. Surgical treatment often represents the only effective weapon for the cure of this disease and over the years different approaches have been developed that can reach the region of the foramen or external to it, with different degrees of invasiveness. The diagnosis is more demanding and still underestimated as it requires a more detailed knowledge in the spine anatomy and dedicated radiological studies. Computerized tomography and in particular magnetic resonance imaging are the appropriate tools for the diagnosis of FLLDH. Despite the widespread use of these diagnostic tests, many cases of FLLDH are overlooked due to insufficiently detailed radiological examinations or due to the execution of exams not focused to the foraminal or the extraforaminal region. Neurophysiological studies represent a valid aid in the diagnostic classification of this pathology and in some cases they can facilitate the differential diagnosis with other types of radiculopathies. In the present study, a comprehensive review of the clinical presentation, epidemiology, radiological study and the neurophysiological aspects is presented.
Core Tip: Far lateral lumbar disc herniations constitute a distinct category of lumbar disc herniations. Clinical presentation, diagnosis and treatment are more demanding and require specific knowledge. A comprehensive review of the clinical presentation, epidemiology, radiological study, and neurophysiological aspects is presented in the present study.
