PMC6410447_01
Lumbar MRI of case 1, 4 weeks after surgery.
CRIM2019-5724342.011.jpg
PMC6410447_01_CRIM2019-5724342.011.jpg
fig11
Postoperative MRI showed a good decompression with a very small rest disc piece inside the canal sacral (Figure 11).
Lumbar MRI of case 1 showing highly migrated disc L5-S1 herniation inside the sacral canal.
CRIM2019-5724342.013.jpg
PMC6410447_01_CRIM2019-5724342.013.jpg
fig13
The MRI of the lumbar spine (Figure 13) showed a large highly caudally migrated disc herniation in the left side.
PMC6410447_02
Bone drill through the S1 pedicle.
CRIM2019-5724342.004.jpg
PMC6410447_02_CRIM2019-5724342.004.jpg
fig4
We performed the surgery through the pedicle S1 left-side (Figure 4).
Endoscopic view of the sequester inside the sacral canal and after removing and decompressing the S1 root.
CRIM2019-5724342.008.jpg
PMC6410447_02_CRIM2019-5724342.008.jpg
fig8
Through the bone hole of the S1 pedicle, we found a large sequester (Figure 8(a)); and after removing the sequester by flexible forceps, the S1 root was found floating freely inside the canal (Figure 8(b)).
Postoperative lumbar MRI with completely removed sequester and bone hole through the pedicle.
CRIM2019-5724342.012.jpg
PMC6410447_02_CRIM2019-5724342.012.jpg
fig12
Control MRI (Figure 12) showed a complete removal of the sequester and relieved S1 root after 4 weeks.
Lumbar MRI of case 2 with large left side caudally dislocated herniation.
CRIM2019-5724342.014.jpg
PMC6410447_02_CRIM2019-5724342.014.jpg
fig14
The MRI scan of the lumbar spine (Figure 14) revealed a huge highly caudally migrated herniation with left side compression of S1.
PMC6410447_03
Working tube inside the hole of the S1 pedicle with discography over extra puncture.
CRIM2019-5724342.006.jpg
PMC6410447_03_CRIM2019-5724342.006.jpg
fig6
The caudally migrated sequester was visible by contrast dyeing (Figure 6, red arrow).
Endoscopic view to the pedicle hole of S1 with blue-stained sequester and after removing the sequester.
CRIM2019-5724342.009.jpg
PMC6410447_03_CRIM2019-5724342.009.jpg
fig9
We removed 2 pieces of disc sequester through the bone hole (Figure 9), and the S1 root was visually seen under endoscopic view (Figure 9).
Lumbar CT 1 day after surgery of case 3 with bone hole of the pedicle.
CRIM2019-5724342.010.jpg
PMC6410447_03_CRIM2019-5724342.010.jpg
fig10
The postoperative CT examination showed the access way through the S1 pedicle and the bone hole (Figure 10, red arrow).
Lumbar MRI of case 3 with left-side S1 compression.
CRIM2019-5724342.015.jpg
PMC6410447_03_CRIM2019-5724342.015.jpg
fig15
The MRI showed a free sequester caudally dislocated to the left side of the canal sacral (Figure 15; red arrow).