{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T04:07:49Z","timestamp":1747282069608,"version":"3.40.5"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:00:00Z","timestamp":1747180800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:00:00Z","timestamp":1747180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Method<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Adequate decompression requires sufficient resection of the L5 lower vertebral body bony spur, transverse process, and sacral ala as a ventral margin.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00701-025-06553-0","type":"journal-article","created":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T06:18:23Z","timestamp":1747203503000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How I do it: minimally invasive surgical decompression for lumbosacral extraforaminal stenosis (Far-Out Syndrome)"],"prefix":"10.1007","volume":"167","author":[{"given":"Subum","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunghyun","family":"Kwon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seok-Joon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun-Hyeok","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,14]]},"reference":[{"key":"6553_CR1","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1007\/978-3-031-44984-0_38","volume-title":"Atlas of Sciatica: Etiologies, Diagnosis, and Management","author":"A Akhaddar","year":"2023","unstructured":"Akhaddar A (2023) Lumbosacral Extraforaminal Stenosis (Far-Out Syndrome). In: Akhaddar A (ed) Atlas of Sciatica: Etiologies, Diagnosis, and Management. Springer International Publishing, Cham, pp 531\u2013536. https:\/\/doi.org\/10.1007\/978-3-031-44984-0_38"},{"key":"6553_CR2","doi-asserted-by":"publisher","first-page":"610","DOI":"10.3109\/02841859609177684","volume":"37","author":"M Hashimoto","year":"1996","unstructured":"Hashimoto M, Watanabe O, Hirano H (1996) Extraforaminal stenosis in the lumbosacral spine: efficacy of MR imaging in the coronal plane. Acta Radiol 37:610\u2013613. https:\/\/doi.org\/10.3109\/02841859609177684","journal-title":"Acta Radiol"},{"key":"6553_CR3","doi-asserted-by":"publisher","first-page":"145","DOI":"10.4184\/asj.2014.8.2.145","volume":"8","author":"H Iwasaki","year":"2014","unstructured":"Iwasaki H, Yoshida M, Yamada H, Hashizume H, Minamide A, Nakagawa Y, Kawai M, Tsutsui S (2014) A new electrophysiological method for the diagnosis of extraforaminal stenosis at L5\u2013S1. Asian Spine J 8:145\u2013149. https:\/\/doi.org\/10.4184\/asj.2014.8.2.145","journal-title":"Asian Spine J"},{"key":"6553_CR4","doi-asserted-by":"publisher","first-page":"E169","DOI":"10.1097\/00007632-200203150-00020","volume":"27","author":"M Matsumoto","year":"2002","unstructured":"Matsumoto M, Chiba K, Nojiri K, Ishikawa M, Toyama Y, Nishikawa Y (2002) Extraforaminal entrapment of the fifth lumbar spinal nerve by osteophytes of the lumbosacral spine: anatomic study and a report of four cases. Spine (Phila Pa 1976) 27:E169-173. https:\/\/doi.org\/10.1097\/00007632-200203150-00020","journal-title":"Spine (Phila Pa 1976)"},{"key":"6553_CR5","doi-asserted-by":"publisher","first-page":"342","DOI":"10.3171\/spi.2006.4.4.342","volume":"4","author":"M Matsumoto","year":"2006","unstructured":"Matsumoto M, Chiba K, Ishii K, Watanabe K, Nakamura M, Toyama Y (2006) Microendoscopic partial resection of the sacral ala to relieve extraforaminal entrapment of the L-5 spinal nerve at the lumbosacral tunnel. Technical note. J Neurosurg Spine 4:342\u2013346. https:\/\/doi.org\/10.3171\/spi.2006.4.4.342","journal-title":"J Neurosurg Spine"},{"key":"6553_CR6","doi-asserted-by":"publisher","first-page":"72","DOI":"10.3171\/2009.7.Spine09344","volume":"12","author":"M Matsumoto","year":"2010","unstructured":"Matsumoto M, Watanabe K, Ishii K, Tsuji T, Takaishi H, Nakamura M, Toyama Y, Chiba K (2010) Posterior decompression surgery for extraforaminal entrapment of the fifth lumbar spinal nerve at the lumbosacral junction. J Neurosurg Spine 12:72\u201381. https:\/\/doi.org\/10.3171\/2009.7.Spine09344","journal-title":"J Neurosurg Spine"},{"key":"6553_CR7","doi-asserted-by":"publisher","first-page":"871","DOI":"10.14245\/ns.2142146.073","volume":"18","author":"M-K Park","year":"2021","unstructured":"Park M-K, Son S-K, Park WW, Choi S-H, Jung DY, Kim DH (2021) Unilateral biportal endoscopy for decompression of extraforaminal stenosis at the lumbosacral junction: surgical techniques and clinical outcomes. Neurospine 18:871\u2013879. https:\/\/doi.org\/10.14245\/ns.2142146.073","journal-title":"Neurospine"},{"key":"6553_CR8","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1016\/j.spinee.2015.02.011","volume":"15","author":"M Takeuchi","year":"2015","unstructured":"Takeuchi M, Wakao N, Kamiya M, Hirasawa A, Osuka K, Joko M, Kawanami K, Takayasu M (2015) Lumbar extraforaminal entrapment: performance characteristics of detecting the foraminal spinal angle using oblique coronal MRI. A multicenter study. Spine J 15:895\u2013900. https:\/\/doi.org\/10.1016\/j.spinee.2015.02.011","journal-title":"Spine J"},{"key":"6553_CR9","doi-asserted-by":"publisher","first-page":"809","DOI":"10.3171\/2021.8.SPINE21962","volume":"36","author":"S Tamagawa","year":"2022","unstructured":"Tamagawa S, Okuda T, Nojiri H, Sato T, Momomura R, Ohara Y, Hara T, Ishijima M (2022) Anatomy of the L5 nerve root in the pelvis for safe sacral screw placement: a cadaveric study. J Neurosurg Spine 36:809\u2013814. https:\/\/doi.org\/10.3171\/2021.8.SPINE21962","journal-title":"J Neurosurg Spine"},{"key":"6553_CR10","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1097\/00007632-198401000-00008","volume":"9","author":"LL Wiltse","year":"1984","unstructured":"Wiltse LL, Guyer RD, Spencer CW, Glenn WV, Porter IS (1984) Alar transverse process impingement of the L5 spinal nerve: the far-out syndrome. 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Informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"139"}}