18 Case Presentations and Surgical Technique: Percutaneous Endoscopic Lumbar Diskectomy: Herniated Disk with Downward Migration at the L4-L5 Level
10.1055/b-0034-82103
18 Case Presentations and Surgical Technique: Percutaneous Endoscopic Lumbar Diskectomy: Herniated Disk with Downward Migration at the L4-L5 Level
Clinical Findings
A patient presented with right posterior sciatica having lasted for 6 months.
The VAS was 9/10 for right leg pain and 3 to 4/10 for back pain.
MRI studies and a CT scan with topogram revealed a central soft herniated disk with downward migration at the L4-L5 level compressing the thecal sac and traversing the nerve root (Fig. 18.54).
Preoperative Plan
The skin entry point and needle trajectory are determined as indicated in Fig. 18.55.
The skin entry point in cases of lower lumbar disk herniation lies more lateral to the midline (13.5 cm in this case) as compared with cases of upper lumbar herniation (6 to 9 cm).
Fig. 18.54 Sagittal (A) and axial (B,C) MRIs and CT scan with topogram (D) revealing a central soft herniated disk with downward migration at the L4-L5 level compressing the thecal sac and traversing nerve root.Fig. 18.55 Axial MRI is used to determine the skin entry point and needle trajectory for this case (arrows).
Only gold members can continue reading. Log In or Register to continue
Jul 12, 2020 | Posted by drzezo in NEUROSURGERY | Comments Off on 18 Case Presentations and Surgical Technique: Percutaneous Endoscopic Lumbar Diskectomy: Herniated Disk with Downward Migration at the L4-L5 Level
5 Anesthesia
18 Case Presentations and Surgical Technique: Percutaneous Endoscopic Lumbar Diskectomy: Paramedian Extrusion at the L2-L3 Level
12 Case Presentations and Surgical Technique: Percutaneous Endoscopic Thoracic Diskectomy
18 Case Presentations and Surgical Technique: Percutaneous Endoscopic Lumbar Diskectomy: L4-L5 Level Paramedian Disk Herniation
16 Surgical Technique for Migrated Disk with Foraminoplasty
20 Complications in Percutaneous Endoscopic Lumbar Diskectomy
