case_images: PMC5288505_01
case_images: The preoperative anteroposterior (A) and left lateral (B) X-ray images of the patient, showing lumbar scoliosis, lumbar degeneration, and vertebral instability.
case_images: CRIOR2017-7439016.001.jpg
case_images: PMC5288505_01_CRIOR2017-7439016.001.jpg
case_images: fig1
case_images: The lumbar X-ray examination revealed lumbar scoliosis, lumbar degeneration, and L2 vertebral slip (Figure 1).
case_images: 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.
case_images: CRIOR2017-7439016.002.jpg
case_images: PMC5288505_01_CRIOR2017-7439016.002.jpg
case_images: fig2
case_images: 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).
case_images: 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.
case_images: CRIOR2017-7439016.003.jpg
case_images: PMC5288505_01_CRIOR2017-7439016.003.jpg
case_images: fig3
case_images: 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).
case_images: The location pictures after successfully reaching the operation area at L4-5 with a guide bar.
case_images: CRIOR2017-7439016.004.jpg
case_images: PMC5288505_01_CRIOR2017-7439016.004.jpg
case_images: fig4
case_images: 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.
case_images: The sight under the endoscope at L4-5 (A); the herniation mass and bone hyperplasia were collected at the plate (B).
case_images: CRIOR2017-7439016.005.jpg
case_images: PMC5288505_01_CRIOR2017-7439016.005.jpg
case_images: fig5
case_images: All of the resected mass was collected on a plate (Figure 5), and the irrigation, meticulous hemostasis, and suture were done as described above.
case_images: 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.
case_images: CRIOR2017-7439016.006.jpg
case_images: PMC5288505_01_CRIOR2017-7439016.006.jpg
case_images: fig6
case_images: 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).