Far lateral and related lumbar disc herniations that feature cephalad migration of fragments away from their disc space of origin can no longer be considered rare. Contemporary imaging techniques now reveal these herniations commonly. The anatomy of the foraminal and extraforaminal (far lateral) regions has been described and should be familiar to all spine surgeons. Each surgeon should be capable of recognizing the distinct entity of the far lateral disc herniation and should be adept at surgery in this region by one of several available techniques. I prefer a posterior, direct microsurgical approach through a midline incision featuring foraminotomy because of its ease, exposure, adaptability, and efficacy.