The Usefulness of Percutaneous Endoscopic Technique in Multifocal Lumbar Pathology

Figure 4

Extraforaminal disc herniation combined with central canal stenosis. (a) Preoperative sagittal and axial T2-weight MRI showing foraminal disc herniation combined with central canal stenosis. Red arrows: extraforaminal disc; red circle: stenotic region in spinal canal. (b) Postoperative axial and sagittal T2-weight MRI showing decompressed thecal sac and contralateral L4 root after removal of extraforaminal disc herniation at L4-5. Red arrows: decompressed area by removal of extraforaminal disc; red circle: enlarged spinal canal from preoperative stenosis. (c) Contralateral extraforaminal disc seen under the contralateral exiting root. Asterisk: ruptured extraforaminal disc; green dotted line: inferior margin of contralateral exiting root; blue dotted line: contralateral margin of thecal sac. (d) Intraoperative C-Arm image showing the location of forceps grasping protruded contralateral extraforaminal disc materials. (e) Decompressed both contralateral exiting and traversing root. Asterisk: removed site of extraforaminal disc. Blue dotted line: contralateral exiting and traversing root.

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