The pain is extremely severe in intensity (9\/10 on a scale of 0 to10). The patient describes the pain as sharp, stabbing, burning. The pain is constant and does not disturb sleep. The pain is associated with tingling, numbness, radiating pain, limping. The patient\u2019s torso is bent to left due to pain and he walks with a discomfort.\u00a0<\/span><\/p>\n The pain is not associated with swelling, bruising, bowel or bladder abnormality, hand function difficulty. The patient\u2019s symptoms had worsened over time. Activities such as walking, standing, lifting, exercise, twisting, lying in bed, bending, squatting, kneeling, stairs, sitting make the symptoms worse. Rest, heat, ice, lying down, bending forwards makes the symptoms better.<\/span><\/p>\n He has tried medications and rest along with therapy treatment as per his PCP but has had no relief. The patient is currently working as an assistant in a dental office. The constant pain has affected her daily activities and she is currently out of work secondary to pain. The patient does not smoke, is on no medications, and has no allergies.<\/span><\/p>\n On general physical examination, the patient is calm, conscious, cooperative, and well oriented to time place and person. On examination of the lumbar spine, the patient is tender to palpation over the paraspinal musculature. There is no tenderness over the spinous processes and there is no crepitus with ranging.\u00a0<\/span><\/p>\n The range of motion of the lumbar spine was limited due to discomfort. An obvious sciatic list to the left side is present. There is a positive straight leg raise test on the right at 30 degrees and contralateral of the left at 40 degrees. There is no tenderness to palpation over the trochanteric bursa and hip.\u00a0<\/span><\/p>\n There is no soft tissue swelling and ecchymosis. The patient has a full range of motion of the hips. The hips are stable on the examination. There are no erythema, warmth, or skin lesions present.<\/span><\/p>\n Range of motion:<\/strong><\/p>\n Flexion (Normal – 60 degrees) – 40<\/span><\/p>\n Extension (Normal – 45 degrees) – 30<\/span><\/p>\n Lateral Flexion Right (Normal – 45 degrees) – 30<\/span><\/p>\n Lateral Flexion Left (Normal – 45 degrees) – 30<\/span><\/p>\n X-ray of the LS spine suggested degenerative changes and moderate dextroscoliosis.<\/span><\/p>\n LS Spine X-ray in AP and Lateral views.<\/strong><\/p>\n MRI of the LS spine suggested a posterior<\/span> extruded disc herniation<\/span><\/a> at the L4-L5 level causing severe<\/span> spinal canal stenosis<\/span><\/a> and compression of descending L5 nerve roots. Right paramedian posterior disc herniation L4-L5 level causing mild spinal canal stenosis and degenerative changes.<\/span><\/p>\n MRI of LS spine in sagittal and axial sections.<\/strong><\/p>\n Her pain and weakness had been worsening, so she presented to the hospital where she was admitted for the same. Her Imaging studies were reviewed and discussed with the patient at length.\u00a0<\/span><\/p>\n We discussed treatment options and the patient opted for surgical management. Risks and complications Including Infection, bleedIng, Injury to nerves and vessels, aggravation of symptoms, aggravation of pain, future instability, and need for future surgery, back pain, rehabilitation among others. The patient understood and signed the informed consent.<\/span><\/p>\n![\"LS](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2020\/06\/Microdiscectomy-189x300.jpg\" "\\"LS")
![\"LS](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2020\/06\/Microdiscectomy2-186x300.jpg\" "\\"LS")
<\/p>\n![\"MRI](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2020\/06\/Microdiscectomy3-288x300.jpg\" "\\"MRI")
![\"MRI](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2020\/06\/Microdiscectomy4.jpg\" "\\"MRI")
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