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Extreme-lateral lumbar disc herniations. Clinical syndrome and special problems of diagnosis.

✓ The authors believe that posterior lumbar disc herniations that occur far laterally (beneath, or beyond the facet) present a clinical picture and special problems of diagnosis different from those encountered with the usual herniations within the spinal canal. In a series of 204 consecutive disc operations, there were 24 “extreme-lateral” disc herniations at the second, third, or fourth lumbar interspace, none at the lumbosacral joint. When compared with the incidence of posterior herniations above the fourth interspace, it appeared that “extreme-lateral” herniations were responsible for the majority of second, third and fourth lumbar root compressions. The clinical syndrome is characterized by anterior thigh and leg pain, absent knee jerk, and sensory loss in the appropriate dermatome but also by the absence of back pain, typical back signs, or positive Lasegue's sign. Reproduction of pain and paresthesia by lateral bending to the side of the lesion is a reliable diagnostic sign. The authors report tha...