Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2025; 16(7): 106570
Published online Jul 18, 2025. doi: 10.5312/wjo.v16.i7.106570
Minimally invasive treatment of far lateral lumbar disc herniation: Selective nerve root block with percutaneous transforaminal endoscopic discectomy
Bing Xiao, Xin Gu, Jia-Yi Zhang, Xiao-Jian Ye, Yan-Hai Xi, Guo-Hua Xu, Wei-Heng Wang
Bing Xiao, Yan-Hai Xi, Guo-Hua Xu, Wei-Heng Wang, Department of Orthopaedics, The Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
Xin Gu, Xiao-Jian Ye, Department of Orthopaedics, Tongren Hospital, Shanghai 200336, China
Jia-Yi Zhang, Medical Services Section, The Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
Co-first authors: Bing Xiao and Xin Gu.
Co-corresponding authors: Guo-Hua Xu and Wei-Heng Wang.
Author contributions: Xiao B, Xu GH and Wang WH contributed to the conception of the study and design of the study; Xiao B and Gu X wrote the manuscript; Xiao B and Zhang JY collected the data and performed the data analysis. Xi YH and Ye XJ reviewed the final draft. Gu X and Wang WH performed all surgical treatments. All authors read and approved the final manuscript. Both Wang WH and Xu GH have played important and indispensable roles in the experimental design and manuscript preparation as the co-corresponding authors.
Supported by the National Key R&D Program of China, No. Key Special Project for Marine Environmental Security and Sustainable Development of Coral Reefs 2022-3.5; and the National Natural Science Foundation of China, No. 82102605; 82472458, and 82272533.
Institutional review board statement: This study was approved by the ethical committee of the Shanghai Changzheng Hospital and the ethical committee of Shanghai Tongren Hospital.
Informed consent statement: The patients provided their written informed consent to participate in this study.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: The original contributions presented in the study are included in the article material, further inquiries can be directed to the corresponding author.
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: Wei-Heng Wang, PhD, Associate Chief Physician, Associate Professor, Department of Orthopaedics, The Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai 200003, China. wangweiheng01@163.com
Received: March 3, 2025
Revised: March 28, 2025
Accepted: May 26, 2025
Published online: July 18, 2025
Processing time: 137 Days and 16.9 Hours
Abstract
BACKGROUND

Far lateral lumbar disc herniation (FLLDH) is a special type of lumbar disc herniation with high rate of missed diagnosis. Selective nerve root block (SNRB) has special advantages in identifying the responsible nerve root. Percutaneous transforaminal endoscopic discectomy (PTED) is a minimally invasive and effective method to treat FLLDH. However, no report has investigated PTED combined with SNRB to treat FLLDH.

AIM

To explore the diagnosis and treatment process, surgical technique and clinical efficacy of PTED combined with SNRB to treat FLLDH.

METHODS

This is a multicenter center, retrospective, observational study. Between January 2020 and January 2022, 32 patients were initially diagnosed with FLLDH. All the patients were identified using SNRB to determine the responsible segment and involved nerve roots. Because of poor symptomatic control following SNRB, 2 patients were excluded. 30 patients diagnosed with FFLDH underwent PTED. The clinical characteristics, operative and postoperative outcomes, complication and subsequent follow-up were collected.

RESULTS

30 patients who underwent SNRB combined with PTED were followed up. The average visual analogue scale (VAS)-leg score, VAS-back score, Oswestry disability index (ODI) score at the Follow-up (1 day, 1 month, 3 months and last follow-up) were significantly different compared per-operation. According to the modified Macnab efficacy evaluation standard, the satisfaction degree at the last follow-up was excellent (28, 93.33%), good (1, 3.33%), medium (1, 3.33%) and poor (0, 0%).

CONCLUSION

SNRB provides an effective method for the definite diagnosis of FLDH and responsible nerve roots. Combination therapy offers several advantages including minimal invasiveness, precision, effectiveness, safety and low recurrence rates.

Keywords: Far lateral lumbar disc herniation; Selective nerve root block; Percutaneous transforaminal endoscopic discectomy; Diagnosis; Minimally invasive treatment

Core Tip: This study assessed percutaneous transforaminal endoscopic discectomy (PTED) combined with selective nerve root block (SNRB) for far lateral lumbar disc herniation (FLLDH) in 30 prospectively recruited patients. The clinical characteristics, operative and postoperative outcomes, complication and subsequent follow-up were collected. These results suggest that SNRB provides an effective method for the definite diagnosis of FLDH and responsible nerve roots. SNRB combined with PETD for treating FLLDH offers several advantages including minimal invasiveness, precision, effectiveness, safety and low recurrence rates, thus warranting further investigation.