A middle-aged female doctor presented to the casualty in the morning with severe sharp shooting pain in the right leg. She had a history of low back pain on & off for one year. Suddenly she started noticing pain radiating to the right leg after bending forward slightly. The pain was severe to the point of complete disability. She couldn’t walk even two steps & had numbness right leg. Power was 3/5 & absent reflexes (Achilles) right.
Urgent MRI was done – findings were of large L5-S1 para-central disc extrusion with high-grade inferior migration compressing the S1 nerves. Diagnosed with lumbar radiculopathy on clinical correlation.
This was an acute onset presentation and needed urgent treatment to relieve her symptoms. Even a delay of 24 hours could lead to a major weakness in lower limbs and loss of bowel and bladder functions. It could make her bedridden and increase her dependence on the family.
Earlier open spine surgery would need more tissue destruction & increased days of hospitalization with further rehabilitation. Endoscopic discectomy by Interlaminar approach provides a good area for visualization and adequate removal of the large extruded para-central disc. The incision size is less than 8mm, hence recovery is faster with less tissue damage.
The patient was advised emergency endoscopic discectomy under epidural Anaesthesia. Immediate decompression by Endoscopic discectomy (interlaminar approach) of the inferior migrated disc was done to relieve pain. Timely done advanced endoscopic spine surgery not only helped with back pain & leg pain but also prevented further progression of nerve compression related problems.
Her recovery was excellent with immediate pain relief. She was mobilized next day and discharged very next day with some instructions to follow the initial weeks. She eventually could get back to work within weeks and do her routine work pain-free. A huge risk was averted due in time by Endoscopic Spine surgery again.