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

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