This a case of a 48 year old female who presented with back and right leg pain. The leg pain radiated to the bottom of the foot and was worsening despite conservative management. She also had numbness in her right foot as well as weakness in the right ankle.
Preliminary lumbar spine x-ray showing mold degeneration at L5/S1
MRI lumbar spine. Sagittal image (left) shows disc herniation at L5/S1 level. Axial images (right) show disc herniation causing compression of the nerves within the spinal canal. The red arrow in the top image is pointing to the nerves within the spine. The bottom two images show the large disc herniation (white arrow) , notice that the nerves cannot be seen.
An intraoperative x-ray images acquired from the fluoroscope. It shows surgical instruments (red arrow) approaching the L5/S1 disc space (white arrow).
Diagram illustrating the bone removal (eg. Hemilaminectomy) and the trajectory used to expose the disc space (red arrow).
Intraoperative photo taken using the surgical microscope. The hemilaminectomy has been performed and the dura is exposed. The disc is protruding upward – toward the viewer-(blue arrow) and the compressed dura above it.
Surgical video showing removal of a large fragment of herniated disc material.
Intraoperative photo after the disc has been removed
A photograph showing the large disc fragment that has been removed from the spinal canal. It measures approximately 4cm (1 3/8 inches).