Minimally invasive surgical decompression for lumbosacral extraforaminal stenosis (Far-Out Syndrome)

Acta Neurochirurgica (2025) 167:139

The document discusses a minimally invasive surgical technique for decompressing lumbosacral extraforaminal stenosis, known as “far-out syndrome,” focusing on the L5 nerve root. It highlights the procedure, indications, potential complications, and the importance of specific imaging techniques for accurate diagnosis and effective treatment.

• The study focuses on minimally invasive surgical decompression for lumbosacral extraforaminal stenosis, known as “far-out syndrome”.

• Accurate diagnosis is challenging due to unique anatomical characteristics, requiring oblique coronal MR imaging for detection.

• The procedure involves a paraspinal approach using a tubular retractor to decompress the L5 nerve root.

• Adequate decompression requires the resection of the L5 lower vertebral body bony spur, transverse process, and sacral ala.

• Key surgical landmarks include the transverse process, sacral ala, and superior articular process, which are drilled to relieve nerve compression.

• Common symptoms include unilateral leg pain, weakness, and neurogenic claudication, often presenting unilaterally.

• Surgical indications involve unilateral radiating leg pain resistant to conservative management and MRI evidence of extraforaminal compression.

• Complications can be avoided by ensuring adequate decompression and removing ventral bony spurs.

Total En Bloc Spondylectomy for Lumbar Spinal Tumors by Paraspinal Approach

World Neurosurg. (2018)120:28-35

OBJECTIVE: To report and describe a modified posterioronly
approach (paraspinal approach) for total en bloc
spondylectomy (TES) of lumbar spinal tumors.

METHODS: From February 2013 to June 2014, 5 patients
with lumbar spinal tumors who underwent TES through a
posterior-only paraspinal approach were studied retrospectively;
operative time, blood loss, complications,
neurologic outcomes, and degree of resection were
recorded to evaluate the efficacy of this surgical method.

RESULTS: Patients included 3 men and 2 women with a
mean age of 48.4 years (range, 46e52 years). Two lesions
were located in L2, 2 lesions were located in L3, and 1
lesion was located in L4. Three patients had solitary
metastatic tumors (lung cancer in 2 cases, breast cancer
in 1 case), and 2 patients had primary tumors (osteosarcoma
and plasma cell tumor). According to the surgical
classification of spinal tumors by Tomita et al., 4 cases
were type 4 and 1 case was type 1. Mean operative time
was 464 minutes (range, 420-510 minutes), and mean
blood loss was 1280 mL (range, 1000-1500 mL). One
patient had cerebrospinal fluid leakage, and 1 had transient
motor weakness because of nerve root traction.
Mean follow-up time was 20.6 months (range, 12e30
months), and all patients had improved or stable neurologic
function. No local recurrence was observed at last
follow-up.

CONCLUSIONS: The posterior-only paraspinal approach
is a valid alternative for TES of lumbar spinal tumors,
especially for overweight or muscular patients.