Far-out syndrome (FOS) is a rare spinal disorder primarily caused by the compression of the L5 nerve root between the L5 transverse process and the sacral ala, leading to severe lower back pain, leg pain, and functional impairment. The underlying causes include osteophyte formation, pseudarthrosis, thickened lumbosacral ligaments, ligamentum flavum hypertrophy, intervertebral disc degeneration, and anatomical variations such as transitional vertebrae. Diagnosing FOS is challenging and requires a combination of imaging techniques (such as MRI and CT) and neurophysiological testing. For patients with mild to moderate symptoms, non-surgical treatments, including medications and physical therapy, may be effective. However, for those with severe symptoms or cases unresponsive to conservative treatment, minimally invasive surgery, such as unilateral biportal endoscopic decompression (UBE), is the preferred option. This article reviews the etiology, pathogenesis, diagnosis, and treatment of FOS and presents a case report of a 67-year-old female patient who successfully underwent UBE surgery, demonstrating the efficacy and potential of this technique.
Key words
Far-out syndrome /
  /
  /
UBE /
  /
  /
  /
Anatomical variation
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Wiltse LL, Guyer RD, Spencer CW, et al. Alar transverse process impingement of the L5 spinal nerve: the far-out syndrome[J]. Spine (Phila Pa 1976), 1984, 9(1):31-41. DOI: 10.1097/00007632-198401000-00008.
[2] Matsumoto M, Watanabe K, Ishii K, et al. Posterior decompression surgery for extraforaminal entrapment of the fifth lumbar spinal nerve at the lumbosacral junction[J]. J Neurosurg Spine, 2010,12(1):72-81. DOI: 10.3171/2009.7.SPINE09344.
[3] 戴力扬, 贾连顺. 腰骶部移行椎与腰痛的关系[J]. 中国临床解剖学杂志, 1998, 16(3):51-53. DOI:CNKI:SUN:ZLJZ.0.1998-03-020
[4] Ise S, Abe K, Orita S, et al. Surgical treatment for far-out syndrome associated with abnormal fusion of the L5 vertebral corpus and L4 hemivertebra: a case report[J]. BMC Res Notes, 2016,9:329. DOI: 10.1186/s13104-016-2123-2.
[5] Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects[J]. Spine (Phila Pa 1976), 1984, 9(5):493-495. DOI: 10.1097/00007632-198407 000-00014.
[6] Takeuchi M, Wakao N, Kamiya M, et al. Lumbar extraforaminal entrapment: performance characteristics of detecting the foraminal spinal angle using oblique coronal MRI. A multicenter study[J]. Spine J, 2015,15(5):895-900. DOI: 10.1016/j.spinee.2015.02.011.
[7] Kitamura M, Eguchi Y, Inoue G, et al. A case of symptomatic extra-foraminal lumbosacral stenosis (“far-out syndrome”) diagnosed by diffusion tensor imaging[J]. Spine (Phila Pa 1976), 2012,37(14):E854-857. DOI: 10.1097/BRS.0b013e318249537f.
[8] Ichihara K, Taguchi T, Hashida T, et al. The treatment of far-out foraminal stenosis below a lumbosacral transitional vertebra: a report of two cases[J]. J Spinal Disord Tech, 2004,17(2):154-157. DOI: 10.1097/00024720-200404000-00013.
[9] Park Y-K, Kim JH, Chung HS, et al. Microsurgical midline approach for the decompression of extraforaminal stenosis in L5-S1[J]. J Neurosurg,2003,98(3 Suppl):264-270. DOI: 10.3171/spi. 2003.98. 3.0264.
[10] 徐宝山, 张凯辉, 田和顺,等. 椎间孔外入路单侧双通道内镜技术在治疗椎管外腰骶神经根卡压症中的应用[J]. 中华骨科杂志, 2023, 43(2): 81-88. DOI: 10.3760/cma.j.cn121113-20220716-00397.