Arthroscopic-assisted uniportal spinal surgery with bone-anchored annular repair for far lateral lumbar disc herniation

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.