A Rare Case of L5 -S1 far Lateral Disc Herniation with Severe Radicular Symptoms: Case Report

Jarosław Andrychowski and Dagmara Szymkowicz-Kudełko

Department of Neurology, Neurological Rehabilitation and Kinesytherapy, The Institute of Physiotherapy, The Faculty of Medicine and Health Sciences, University Jan Kochanowski, Kielce, Poland
The Centrum Hospital ENEL-MED Warszawa, Poland
Department of Neurosurgery, The Children’s Memorial Health Institute, Warsaw, Poland

^*Correspondance to: Jaros?aw Andrychowski 

 PDF  Full Text DOI: 10.25107/2474-1647.2168

Abstract

We describe a 60-year-old woman, a professionally active physician, who had recurrent, severe radicular pain in the lower left limb. This pain was due to a Far Lateral Disc Herniation (FLDH) at the L5-S1 level. The patient took medications, underwent rehabilitation, and had per radicular block, but these treatments did not improve her pain. Conservative treatment was given for 6 months. In the differential diagnosis, we included diseases of the sacroiliac joint and the iliolumbar ligament. When the patient developed neurological symptoms that indicated damage of the L5 nerve root, we repeated magnetic resonance imaging of the lumbar spine, which confirmed the L5-S1 herniation. Because the patient worsened clinically, we decided to operate. We performed microsurgery; we did a paramedian incision, separated the multifidus muscles, and used a paramedian extraforaminal approach. We compare this approach to other surgical approaches used to treat patients with lateral herniations. FLDHs account for about 7% of disc herniations. FLDHs usually occur at the L4-L5 level, but are very rare at the L5-S1 level. Because L5-S1 FLDHs are rare, surgeons have little experience in diagnosing and operating patients with this condition. We think that our description of the operating technique that we used to treat our patient with FLDH might help other surgeons to treat their patients.

Keywords

Far Lateral Disc Herniation; Paramedian access; Minimally invasive; L5-S1 level; Anatomical limitations

Cite the article

Andrychowski J, Szymkowicz-Kude?ko D. A Rare Case of L5 -S1 far Lateral Disc Herniation with Severe Radicular Symptoms: Case Report. Clin Surg. 2018; 3: 2168.