# How I do it: minimally invasive surgical decompression for lumbosacral extraforaminal stenosis (Far-Out Syndrome)

## TL;DR

This paper describes a minimally invasive surgical technique for treating a specific type of nerve compression in the lower back.

## Contribution

The paper introduces a specific minimally invasive surgical approach for lumbosacral extraforaminal stenosis.

## Key findings

- A minimally invasive paraspinal approach using a tubular retractor was effective for decompressing the L5 nerve root.
- Adequate decompression requires resection of the L5 lower vertebral body bony spur, transverse process, and sacral ala.
- The technique helps avoid complications and achieve better surgical outcomes.

## Abstract

Accurate diagnosis of extraforaminal entrapment of the L5 nerve root, commonly referred to as "far-out syndrome," is challenging due to its unique anatomical characteristics, which differ from those of other lumbar regions. Inadequate decompression may lead to poor outcomes.

A minimally invasive paraspinal approach utilizing a tubular retractor was used to decompress extraforaminal entrapment of the L5 nerve root. Procedures and discussions regarding indications, diagnoses, surgical endpoints, and ways to avoid complications were described.

Adequate decompression requires sufficient resection of the L5 lower vertebral body bony spur, transverse process, and sacral ala as a ventral margin.

The online version contains supplementary material available at 10.1007/s00701-025-06553-0.