PMC5288505_01
The preoperative anteroposterior (A) and left lateral (B) X-ray images of the patient, showing lumbar scoliosis, lumbar degeneration, and vertebral instability.
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The lumbar X-ray examination revealed lumbar scoliosis, lumbar degeneration, and L2 vertebral slip (Figure 1).
The sagittal (a) and coronal CT images of L3-4 (b) and L4-5 (c) revealed lumbar stenosis combined with intervertebral disc herniation at both levels and combined lumbar facet joint degenerative changes.
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fig2
Topography (CT) indicated a L3-4 and L4-5 lumbar stenosis combined with intervertebral disc herniation and lumbar joint facets degeneration unexpected for his age (Figure 2). The Magnetic Resonance Imaging (MRI) confirmed results from the CT scan but also suggested lumbar stenosis at L3-4 and L4-5; thecal sacs at the both levels were compressed by herniation (Figure 3).
Both the T1 sagittal (a) and coronal MRI images of L3-4 (b) and L4-5 (c) suggested that the herniation and lumbar stenosis compressed the thecal sac at both levels, and lumbar degenerative changes were also reported.
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fig3
Topography (CT) indicated a L3-4 and L4-5 lumbar stenosis combined with intervertebral disc herniation and lumbar joint facets degeneration unexpected for his age (Figure 2). The Magnetic Resonance Imaging (MRI) confirmed results from the CT scan but also suggested lumbar stenosis at L3-4 and L4-5; thecal sacs at the both levels were compressed by herniation (Figure 3).
The location pictures after successfully reaching the operation area at L4-5 with a guide bar.
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After the guide bar being inserted into the posterior of thecal sac (Figure 4), the working channel was rotated around the direction of the guide bar, and the endoscope was introduced.
The sight under the endoscope at L4-5 (A); the herniation mass and bone hyperplasia were collected at the plate (B).
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fig5
All of the resected mass was collected on a plate (Figure 5), and the irrigation, meticulous hemostasis, and suture were done as described above.
Both the T1 sagittal (A) and coronal MRI images of L3-4 (B) and L4-5 (C) at 1-month postoperatively, indicating that the herniation and stenosis at both levels were alleviated compared with the preoperative results, despite edema being observed.
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fig6
MRI scan was done 1 month postoperatively; in addition, the patient reported his LBP 1 of 10 on a VAS scale and 0 of 10 on a VAS scale of leg pain. MRI imaging 1 month postoperatively suggested disc edema at L3-4 and L4-5; herniation and stenosis were alleviated compared with preoperative images (Figure 6).