PMC9968678_01
The preoperative imaging demonstrated obvious L5/S1 level ring apophysis fractures with LDH
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Fig1
The right-straight-leg-raise test was positive and muscle strength of the right lower limb decreased slightly. The preoperative imaging demonstrated obvious L5/S1 level ring apophysis fractures with LDH (Fig. 1).
Confirm the operative segment (a). The standard position of needle tip (b, c). Inject the contrast medium (d). Break through the surface of the ligamentum flavum (e). Final position of working channel (f, g). Traversing nerve root was visualized (h)
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Fig2
The C-arm X-ray fluoroscopy was used to confirm the operative segment (Fig. 2a). The 18 G needle trajectory was introduced with its tip pointed at the lateral edge of the interlaminar window (Fig. 2b, c). Once the puncture needle reached the appropriate location, the contrast medium was injected (Fig. 2d). The needle was then removed, with a 1-mm-diameter guide wire inserted, and a dilator was introduced with its tip puncturing through the surface of the ligamentum flavum (Fig. 2e). A beveled working sheath was then inserted through the dilator with its beveled opening toward the spinal canal (Fig. 2f, g). Different types of forceps were employed for decompression, and then the traversing nerve root was visualized (Fig. 2h).
Asymptomatic residual disc tissue was observed on MRI 3 months after operation
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Fig3
Although asymptomatic residual disc tissue was noted on magnetic resonance imaging (MRI) at the 3-month follow-up post operation (Fig. 3), the patient was able to return to his original high level of activity, without any residual lower back pain at the 6-month follow-up post operation.