A Far Lateral Disc Rupture is when the disk protrudes into the spinal canal in the same way it occurs outside the spine and pushes on the nerve after it has left the spine. A Far Lateral Discectomy is where the prolapsed fragment is removed through a small incision in the back. It is usually done under a surgical microscope. Usually not only is the prolapsed fragment removed but some of the damaged disc is also removed to prevent a further rupture from occurring. The operation to remove the prolapsed fragment is donw from the back and the surgeon operates around the outside of the spine to ge to the prolapsed disc instead of the normal approach into the spine.

Sciatica is the most common reason to have this procedure done, but you may also be experiencing numbness or weakness in your leg(s). If you are having surgery it usually means that the symptoms have not gone away with other therapies such as physiotherapy, rest, and anti-inflammatory medication.

In the operating room, you are given a general anaesthetic and then positioned face down on a special frame. An incision is marked on your back with a special pen, and the entire area is cleansed with antiseptic. You are then covered in drapes so that only the incision can be seen.

A cut is made through the skin down to the fascia. The muscle is split down to the facet joint and the retractor is used to hold this out of the way. The level is checked wiht Xray. The transverse process are identified above and below and this tells us where to expect the nerve to be located. A band of fascia between the transverse processes is opened to find the nerve where it leaves the spine. It is unusual for any bone to need to be removed.

The nerve is gently moved out of the way and the prolapsed disc is removed. This gives more space to allow the removal of as much as possible of what remains of the disc. You can see from the above diagram that it is difficult to completely remove the disc from this approach.

Once this has been done all bleeding is stopped and sometimes a small piece of fat is placed behind the nerve to act as a cushion. The layers are then all sewn back into their normal position. The skin is then closed with either dissolvable stitches or with staples.

You will wake up in the recovery room and after about 1 hour you will be moved to your room. The nurses will be continually checking your vital signs and leg strength monitoring for any signs of complications. During the first night the nurse will wake you for these observations. You will be given injections for pain which will be discussed before surgery. Sometimes you will have difficulty urinating and will require a catheter. You will be encouraged to get up and walk a little. The next day the IV in your arm will be removed after your next walk adn then you will be given oral analgesia. You could go home on this day, or the next depending on your comfort level.

You will be admitted either the day before or the day of surgery. You must be NPO from midnight the night before your surgery. You will be discharged 1 to 2 days post-operatively. On discharge you will be able to perform most daily tasks. Should you notice any of the following symptoms you should contact your doctor immediately:

• Weakness in the legs
• Difficulty passing urine
• Abdominal pain
• Increasing leg pain or numbness
• Fever
• Increasing back pain
• Swelling or infection in the wound

Once you are discharged to go home you will be able to do most things, however you should avoid heavy lifting, twisting, and prolonged sitting. You will not be allowed to drive for 3 to 6 weeks, and you will be allowed to return to work 4 to 6 weeks post-operatively. It is important to walk as much as is comfortable.

The most common risks are:

• Infection (treated with antibiotics)
• Damage to the nerve that is compressed by the disc
• Damage to the dural sac containing the nerves and producing a fluid leak (stops with bed rest_
• Post operative blood clot requiring drainage
• Paraplegia with or without the loss of bowel/bladder function (very rare)
• Clot in the legs (can travel to the lungs, but this is rare)
• Complications not related directly to the surgery are pneumonia, heart attack, and urinary tract infection

There is a chance of a recurrance of the disk prolapse. Because the approach is a small incision it is difficult to completely clear the disk. The younger you are the greater the chance because the disc shrinks with age. Eventually you should be able to do just about all the things that you did in the past. It is important to remember that the disk has been damaged and that some things should be avoided such as heavy lifting. If you had pain, weakness and numbness before surgery, the pain should improve considerably, however the numbness and weakness may not go completely away. This should be discussed with your doctor.