Minimally Invasive Surgery Case of the Day

History:  A 21 year old female dancing student presents with back pain and left sided L5 radicular pain of 3 months durantion.

Findings:  Paraspinal left sided tenderness and a positive left sided straight leg raise test is seen on examination.

Imaging:  MRI reveals a foraminal left sided L5/S1 herniation (arrows)

Procedure:  Transforaminal L5/S1 endoscopic discectomy  is performed as an out-patient procedure through a 0.5cm incision

Surgeon:  George Rappard, MD

Disposition:  The patient is discharged one hour post-procedure with resolution of radiculopathy and reversal of straight leg raise sign

Procedure Images:  

Blue stained herniated disc material is seen through scope (arrow)

Upon exploring foramen, exiting L5 nerve root (arrow) and foraminal extruded disc (star) is seen

The endoscopic bipolar (left) and 2.5mm rongeur (right) are used to remove foraminal herniation.  Arrow denotes exiting and displaced L5 nerve root.

After decompression the annular tear is probed (arrow) for loose intradiscal fragments

The nerve (arrow) is decompressed and the foraminal herniation is now seen as an empty cavity (star)

For more information on endoscopic lumber discectomy contact the Los Angeles Minimally Invasive Spine Institute or go to http://www.lamisinstitute.com/percutaneous-endoscopic-lumbar-discectomy