Far Lateral Disc Herniation | Spine Specialist

An Overview of Far Lateral Disc Herniations
of the Lumbar Spine

“Normal” disc herniations in the lumbar spine occur in the posterolateral position. This is a spot in the spinal canal where the traversing nerve lies. About 95% of the time when a disc herniation occurs, the herniation will occur in this posterolateral position and compress the nerve in the canal.

The reason for the herniation being so common in this location is that the walls of the disc are thinnest and therefore weakest here. This is the site that normally tears through and through. The jelly (nucleus) of the disc will push out (herniate) and compress this traversing nerve. The symptoms are typically pain in the buttocks and leg with sitting that are relieved with standing. There are of course, some exceptions to this rule. See the section on lumbar disc herniations to better understand this concept.

2-5% of the time, a disc herniation in the lumbar spine will occur in the far lateral position. This location is part of the spine outside the spinal canal. The exiting nerve travels through the foramen (exit hole) and lies next to the disc wall here. A far lateral disc herniation will compress the nerve. The nerve becomes tented over the herniation as it exits into the muscle (the psoas) on the side of the spine. Symptoms include buttocks and leg pain but unlike the typical posterolateral herniation, this far lateral herniation can cause pain that may be increased with standing.

Depending upon the nerve involved, pain may occur in the back of the thigh or the front of the thigh and may radiate all the way down the leg. Pain, paresthesias (pins and needles) and numbness are the typical symptoms that may occur with a far lateral disc herniation.

Depending upon the nerve that is affected, weakness may be noticed in the foot (foot drop) or the thigh (quadriceps weakness). If the weakness occurs in the foot, the foot may slap on the ground when walking. Patients with foot drop may trip over their own foot when taking a step. With quadriceps weakness, climbing stairs, getting out of a car or stepping up onto a curb may feel “spongy” or the knee will feel like it will want to “give out”. Falls can occur with quick motions.

Even a radiologist may miss a far lateral disc herniation as the MRI findings may be subtle. The radiologist unfortunately does not have the clinical suspicions developed from actually examining a patient and be unaware of the process causing pain or weakness in a specific nerve.

(Click to Enlarge Image) Normal foraminal view of spine. The black dots in the foramen are the nerve roots surrounded by fat.

(Click to Enlarge Image) Side view of far lateral herniation in the foramen. White arrow.

(Click to Enlarge Image) Top down view of far lateral herniation. Large white arrow pionts to herniation. Small white arrows point to normal and compressed nreves.

Are you suffering from symptoms of a far lateral disc herniation?

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(Please keep reading below for more information on this condition.)

Treatment of a Far Lateral Disc Herniation

Treatment of this lumbar spine disorder is based upon the standard protocol for any disc herniation and is covered by the section on this website under “When to have lumbar surgery”. Many times, surgery can be avoided with proper care. If weakness of a muscle group is noted, unfortunately this is an important indication to consider surgery.

When surgery is required, the surgery is different than the typical posterolateral microdiscectomy. The far lateral herniation is approached through an incision about 3 cm off of midline and splits the erector spinae muscle (the muscle that causes the spine to bend backwards). Since the fibers of the muscle run in line with the incision, this approach is not significantly traumatic.

During the far lateral microdiscectomy, the spinal canal is not entered and the fragment is removed from the side of the spine. Click on the video of the actual surgery to the right if you have unanswered questions.

For additional resources on a far lateral disc herniation of the lumbar spine, please contact the practice of Dr. Donald Corenman, spine specialist and back doctor offering diagnostic and surgical second opinions to patients in the USA and around the world.

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

Far Lateral Disc Herniations – Lumbar Spine

An Overview of Far Lateral Disc Herniations
of the Lumbar Spine

Are you suffering from symptoms of a far lateral disc herniation?

Treatment of a Far Lateral Disc Herniation

Related Content

About the Author: Donald Corenman, MD, DC

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Far Lateral Disc Herniations – Lumbar Spine

An Overview of Far Lateral Disc Herniations of the Lumbar Spine

Are you suffering from symptoms of a far lateral disc herniation?

Treatment of a Far Lateral Disc Herniation

Related Content

About the Author: Donald Corenman, MD, DC

An Overview of Far Lateral Disc Herniations
of the Lumbar Spine