en Neurosurgery Neurosurgery Original Research Original Research <p> <strong> Abstract </strong></p><p> <strong> Background: </strong>Far lateral discal herniation is an uncommon disorder and is difficult </p><p>  to assess by physical examination alone. This study is designed to define clinical and </p><p>  epidemiological findings and to establish the indications of surgical and medical treatment for FLLDH. </p><p> <strong> Methods: </strong>Between 2000 and 2005, a total of 2035 patients with lumbar disc herniation </p><p>  underwent surgical discectomy by the authors in several neurosurgical centers </p><p>  in Mashhad. Among these patients, 63 (3.1%) had FLLDH (42 men and 21 women). </p><p>  Clinically these patients had unilateral radicular pain with or without paresis. SLR </p><p>  was positive in 100% of cases. Conservative therapy consisting of bed rest, nonsteroidal </p><p>  anti-inflammatory drugs and physiotherapy had failed. We used a combination </p><p>  of classical interlaminar approach and the intertransverse route through a midline approach for the treatment of our patients. </p><p>  Results: From 63 cases in our series, 42 were men and 21 were women. 19 patients </p><p>  had extraforaminal and 44 had foraminal disc herniation. The most common level for </p><p>  far lateral discal herniation was L4-L5. Our patients had LBP in 43.6% (27 cases) and </p><p>  positive SLR and radicular leg pain in 100% (63 cases). In all patients leg pain was relieved immediately after surgery. </p><p> <strong> Conclusion: </strong>FLLDH should be considered in all cases with lower limb radiculopathy. </p><p>  These patients have more severe radicular pain than patients with paracentral </p><p>  lumbar disc herniation. FLLDH happens more frequently at L4-L5 and L3-L4 levels. </p><p>  It can often be difficult to diagnose or easily overlooked on radiographic studies. In </p><p>  almost all cases, conservative treatment is unsuccessful and surgical treatment is recommended. </p> far lateral disc, lumbar spine, foraminal and extraforaminal, disc surgery 63 67 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-1-44&slc_lang=en&sid=1 Fariborz Samini SAMINIF@MUMS.ac.ir 20031947532846001589 20031947532846001589 Yes Department of Neurosurgery, Ghaem Medical Center,Mashhad, Iran Gholamreza Bahadorkhan 20031947532846001590 20031947532846001590 No Mashhad Medical University, Mashhad, Iran. Mohammad Reza Ehsaei 20031947532846001591 20031947532846001591 No Mashhad Medical University, Mashhad, Iran. Hamed Kheradmand 20031947532846001592 20031947532846001592 No Mashhad Medical University, Mashhad, Iran.