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Intervertebral Disc Extrusion, Foraminal
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Lateral/far lateral herniation
            • Nonstandard: Lateral or foraminal herniated nucleus pulposus (HNP)
          • Definitions

            • Extruded disc material within neural foramen
            • Far lateral is disc material lateral to neural foramen

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Nonvascular Interventions

                    • Nuclear Medicine Findings

                      • Other Modality Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Daghighi MH et al: Migration patterns of herniated disc fragments: a study on 1,020 patients with extruded lumbar disc herniation. Spine J. 14(9):1970-7, 2014
                                          2. Fardon DF et al: Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the north american spine society, the american society of spine radiology, and the american society of neuroradiology. Spine (Phila Pa 1976). 39(24):E1448-65, 2014
                                          3. Yoshimoto M et al: Microendoscopic discectomy for far lateral lumbar disk herniation: less surgical invasiveness and minimum 2-year follow-up results. J Spinal Disord Tech. 27(1):E1-7, 2014
                                          4. Kotil K et al: A minimally invasive transmuscular approach to far-lateral L5-S1 level disc herniations: a prospective study. J Spinal Disord Tech. 20(2):132-8, 2007
                                          5. Sasani M et al: Percutaneous endoscopic discectomy for far lateral lumbar disc herniations: prospective study and outcome of 66 patients. Minim Invasive Neurosurg. 50(2):91-7, 2007
                                          6. Chang SB et al: Risk factor for unsatisfactory outcome after lumbar foraminal and far lateral microdecompression. Spine (Phila Pa 1976). 31(10):1163-7, 2006
                                          7. Consensus statement on nomenclature and classification of lumbar disc pathology by NASS, ASSR, and ASNR, 2001
                                          8. Narozny M et al: Therapeutic efficacy of selective nerve root blocks in the treatment of lumbar radicular leg pain. Swiss Med Wkly. 131(5-6):75-80, 2001
                                          9. Shao KN et al: Far lateral lumbar disc herniation. Zhonghua Yi Xue Za Zhi (Taipei). 63(5):391-8, 2000
                                          10. Hsieh MS et al: Diagnosis of herniated intervertebral disc assisted by 3-dimensional, multiaxial, magnetic resonance imaging. J Formos Med Assoc. 98(5):347-55, 1999
                                          11. Di Lorenzo N et al: Pars interarticularis fenestration in the treatment of foraminal lumbar disc herniation: a further surgical approach. Neurosurgery. 42(1):87-9; discussion 89-90, 1998
                                          12. Matsui H et al: Familial predisposition for lumbar degenerative disc disease. A case-control study. Spine. 23(9):1029-34, 1998
                                          13. Ashkenazi E et al: Foraminal herniation of a lumbar disc mimicking neurinoma on CT and MR imaging. J Spinal Disord. 10(5):448-50, 1997
                                          14. Weiner BK et al: Foraminal injection for lateral lumbar disc herniation. J Bone Joint Surg Br. 79(5):804-7, 1997
                                          15. Segnarbieux F et al: Disco-computed tomography in extraforaminal and foraminal lumbar disc herniation: influence on surgical approaches. Neurosurgery. 34(4):643-7; discussion 648, 1994
                                          16. Kunogi J et al: Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine. 16(11):1312-20, 1991
                                          17. Varlotta GP et al: Familial predisposition for herniation of a lumbar disc in patients who are less than twenty-one years old. J Bone Joint Surg Am. 73(1):124-8, 1991
                                          18. An HS et al: Herniated lumbar disc in patients over the age of fifty. J Spinal Disord. 3(2):143-6, 1990
                                          19. Osborn AG et al: CT/MR spectrum of far lateral and anterior lumbosacral disk herniations. AJNR Am J Neuroradiol. 9(4):775-8, 1988
                                          20. Jackson RP et al: Foraminal and extraforaminal lumbar disc herniation: diagnosis and treatment. Spine. 12(6):577-85, 1987
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Lateral/far lateral herniation
                                                    • Nonstandard: Lateral or foraminal herniated nucleus pulposus (HNP)
                                                  • Definitions

                                                    • Extruded disc material within neural foramen
                                                    • Far lateral is disc material lateral to neural foramen

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Nonvascular Interventions

                                                            • Nuclear Medicine Findings

                                                              • Other Modality Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Daghighi MH et al: Migration patterns of herniated disc fragments: a study on 1,020 patients with extruded lumbar disc herniation. Spine J. 14(9):1970-7, 2014
                                                                                  2. Fardon DF et al: Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the north american spine society, the american society of spine radiology, and the american society of neuroradiology. Spine (Phila Pa 1976). 39(24):E1448-65, 2014
                                                                                  3. Yoshimoto M et al: Microendoscopic discectomy for far lateral lumbar disk herniation: less surgical invasiveness and minimum 2-year follow-up results. J Spinal Disord Tech. 27(1):E1-7, 2014
                                                                                  4. Kotil K et al: A minimally invasive transmuscular approach to far-lateral L5-S1 level disc herniations: a prospective study. J Spinal Disord Tech. 20(2):132-8, 2007
                                                                                  5. Sasani M et al: Percutaneous endoscopic discectomy for far lateral lumbar disc herniations: prospective study and outcome of 66 patients. Minim Invasive Neurosurg. 50(2):91-7, 2007
                                                                                  6. Chang SB et al: Risk factor for unsatisfactory outcome after lumbar foraminal and far lateral microdecompression. Spine (Phila Pa 1976). 31(10):1163-7, 2006
                                                                                  7. Consensus statement on nomenclature and classification of lumbar disc pathology by NASS, ASSR, and ASNR, 2001
                                                                                  8. Narozny M et al: Therapeutic efficacy of selective nerve root blocks in the treatment of lumbar radicular leg pain. Swiss Med Wkly. 131(5-6):75-80, 2001
                                                                                  9. Shao KN et al: Far lateral lumbar disc herniation. Zhonghua Yi Xue Za Zhi (Taipei). 63(5):391-8, 2000
                                                                                  10. Hsieh MS et al: Diagnosis of herniated intervertebral disc assisted by 3-dimensional, multiaxial, magnetic resonance imaging. J Formos Med Assoc. 98(5):347-55, 1999
                                                                                  11. Di Lorenzo N et al: Pars interarticularis fenestration in the treatment of foraminal lumbar disc herniation: a further surgical approach. Neurosurgery. 42(1):87-9; discussion 89-90, 1998
                                                                                  12. Matsui H et al: Familial predisposition for lumbar degenerative disc disease. A case-control study. Spine. 23(9):1029-34, 1998
                                                                                  13. Ashkenazi E et al: Foraminal herniation of a lumbar disc mimicking neurinoma on CT and MR imaging. J Spinal Disord. 10(5):448-50, 1997
                                                                                  14. Weiner BK et al: Foraminal injection for lateral lumbar disc herniation. J Bone Joint Surg Br. 79(5):804-7, 1997
                                                                                  15. Segnarbieux F et al: Disco-computed tomography in extraforaminal and foraminal lumbar disc herniation: influence on surgical approaches. Neurosurgery. 34(4):643-7; discussion 648, 1994
                                                                                  16. Kunogi J et al: Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine. 16(11):1312-20, 1991
                                                                                  17. Varlotta GP et al: Familial predisposition for herniation of a lumbar disc in patients who are less than twenty-one years old. J Bone Joint Surg Am. 73(1):124-8, 1991
                                                                                  18. An HS et al: Herniated lumbar disc in patients over the age of fifty. J Spinal Disord. 3(2):143-6, 1990
                                                                                  19. Osborn AG et al: CT/MR spectrum of far lateral and anterior lumbosacral disk herniations. AJNR Am J Neuroradiol. 9(4):775-8, 1988
                                                                                  20. Jackson RP et al: Foraminal and extraforaminal lumbar disc herniation: diagnosis and treatment. Spine. 12(6):577-85, 1987