Arthroscopic-assisted uniportal spinal surgery with bone-anchored annular repair for far lateral lumbar disc herniation: A case report.
- 1Orthopedics, Kunming Orthopedic Hospital, Kunming, Yunnan, China.
- 2Department of Orthopedics and Traumatology, Luliang County Traditional Chinese Medicine Hospital, Qujing, Yunnan, China.
- 3Spinal Department, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
Abstract
Rationale
Far lateral lumbar disc herniation (FLLDH) is technically challenging because of its foraminal or extraforaminal location. Arthroscopic-assisted uniportal spinal surgery (AUSS) with bone-anchored annular repair has previously been described for lumbar disc herniation, but its use through an extraforaminal corridor for FLLDH has not been specifically detailed.Patient concerns
A 50-year-old woman presented with a 4-month history of refractory lumbosacral and gluteal pain, followed by acute right lower-extremity radicular pain along the L3-L4 dermatome. Walking was limited to <20 minutes. Her leg-pain visual analog scale (VAS) score was 7, and her Oswestry Disability Index (ODI) was 45/50 (90%) despite conservative treatment.Diagnoses
Computed tomography and magnetic resonance imaging demonstrated a right-sided far-lateral L3-L4 disc herniation with foraminal stenosis and compression of the exiting L3 nerve root. Dynamic radiographs showed no segmental instability.Interventions
The patient underwent AUSS-assisted far lateral discectomy under general anesthesia through a 1.5 to 2.0-cm extraforaminal incision. Foraminal decompression, removal of the herniated nucleus pulposus, and bone-anchored annular repair were performed through the same uniportal approach.Outcomes
The operation lasted 45 minutes, with an estimated blood loss of approximately 10 mL. No perioperative complications were documented. The leg-pain VAS score decreased from 7 to 1, and the ODI decreased from 45/50 (90%) to 10/50 (20%). Postoperative day 1 imaging confirmed removal of the herniated fragment and adequate decompression of the exiting L3 nerve root. At the 15-month telephone-only follow-up, the patient-reported leg-pain VAS score was 0 and the ODI was 8/50 (16%); no physical examination or interval imaging was obtained.Lessons
This case demonstrates the technical feasibility of performing decompression and bone-anchored annular repair for FLLDH through an extraforaminal AUSS corridor. The contribution is the anatomical and procedural application of a previously described repair concept rather than the introduction of a new repair technique. Because the 15-month follow-up was telephone-based and lacked neurological examination and interval imaging, this report does not establish structural healing, recurrence prevention, long-term safety, comparative effectiveness, or superiority.
Related
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BibTeX
@article{cao2026arthroscopicassisted,
title = {{Arthroscopic-assisted uniportal spinal surgery with bone-anchored annular repair for far lateral lumbar disc herniation: A case report.}},
author = {Hao Cao and Xin Zhang and Shili Chen and Dong Liu and Fei Sun and En Song},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051107},
url = {https://europepmc.org/article/MED/42888534},
note = {CC BY},
}
RIS
TY - JOUR
TI - Arthroscopic-assisted uniportal spinal surgery with bone-anchored annular repair for far lateral lumbar disc herniation: A case report.
AU - Hao Cao
AU - Xin Zhang
AU - Shili Chen
AU - Dong Liu
AU - Fei Sun
AU - En Song
PY - 2026
DA - 2026/10/01
JO - Medicine
DO - 10.1097/md.0000000000051107
UR - https://europepmc.org/article/MED/42888534
AB - Rationale Far lateral lumbar disc herniation (FLLDH) is technically challenging because of its foraminal or extraforaminal location. Arthroscopic-assisted uniportal spinal surgery (AUSS) with bone-anchored annular repair has previously been described for lumbar disc herniation, but its use through an extraforaminal corridor for FLLDH has not been specifically detailed.Patient concerns A 50-year-old woman presented with a 4-month history of refractory lumbosacral and gluteal pain, followed by acute right lower-extremity radicular pain along the L3-L4 dermatome. Walking was limited to <20 minutes. Her leg-pain visual analog scale (VAS) score was 7, and her Oswestry Disability Index (ODI) was 45/50 (90%) despite conservative treatment.Diagnoses Computed tomography and magnetic resonance imaging demonstrated a right-sided far-lateral L3-L4 disc herniation with foraminal stenosis and compression of the exiting L3 nerve root. Dynamic radiographs showed no segmental instability.Interventions The patient underwent AUSS-assisted far lateral discectomy under general anesthesia through a 1.5 to 2.0-cm extraforaminal incision. Foraminal decompression, removal of the herniated nucleus pulposus, and bone-anchored annular repair were performed through the same uniportal approach.Outcomes The operation lasted 45 minutes, with an estimated blood loss of approximately 10 mL. No perioperative complications were documented. The leg-pain VAS score decreased from 7 to 1, and the ODI decreased from 45/50 (90%) to 10/50 (20%). Postoperative day 1 imaging confirmed removal of the herniated fragment and adequate decompression of the exiting L3 nerve root. At the 15-month telephone-only follow-up, the patient-reported leg-pain VAS score was 0 and the ODI was 8/50 (16%); no physical examination or interval imaging was obtained.Lessons This case demonstrates the technical feasibility of performing decompression and bone-anchored annular repair for FLLDH through an extraforaminal AUSS corridor. The contribution is the anatomical and procedural application of a previously described repair concept rather than the introduction of a new repair technique. Because the 15-month follow-up was telephone-based and lacked neurological examination and interval imaging, this report does not establish structural healing, recurrence prevention, long-term safety, comparative effectiveness, or superiority.
SN - 0304-5412
SN - 1536-5964
ER -