case_images: PMC10894923_01
case_images: (A) Sagittal plane of preoperative MRI shows spondylosis, marginal osteophytes, and degenerative changes of the disk spaces with desiccation and posterior herniation at the levels of L2/3~L5/S1 which cause compression of the thecal sac. (B) Axial plane of preoperative MRI at L2/3 level shows central canal stenosis and left lateral recess stenosis. (C) Axial plane of preoperative MRI at L3/4 level shows severe central canal stenosis and bilateral lateral recesses stenosis. (D,E) Axial plane of postoperative MRI at L2/3, L3/4 level show no evidence of recurrent disc herniation or epidural hematoma.
case_images: fsurg-11-1329860-g001.jpg
case_images: PMC10894923_01_fsurg-11-1329860-g001.jpg
case_images: F1
case_images: L2/3 and L5/S1. Lumbar spine magnetic resonance imaging (MRI) revealed degenerative disc disease and posterior disc bulging at the levels of L2/3~L5/S1 with compression of the thecal sac (Figures 1A-C). The postoperative lumbar MRI on the next day revealed no evidence of recurrent disc herniation or epidural hematoma (Figures 1D,E).
case_images: (A) The patient was placed in the prone position with upper limbs tucked aside and 6-inch elastic bandages were properly wrapped over bilateral lower limbs from foot to above knee as compression stockings. (B) Invasive arterial blood pressure was recorded every 5 min and no systolic blood pressure was less than 100mmHg. Non-invasion arterial blood pressure was checked every 30 min during operation and no systolic blood pressure was less than 90mmHg. (C,D) Axial plane of pre-operative MRI at L2/3 level, the blue bar indicates the tubular retractor and the view through microscope. Tilting table to the opposite side and undercutting of the spinous process to gain access to the contralateral lateral recess. (E) Axial plane of postoperative MRI at the L2/3 level; the red arrow indicates the surgical access, which appears as a high signal on the MRI.
case_images: fsurg-11-1329860-g002.jpg
case_images: PMC10894923_01_fsurg-11-1329860-g002.jpg
case_images: F2
case_images: The patient was positioned in the prone position with upper limbs tucked aside, and two bolsters were longitudinally placed beneath trunk (Figure 2A). The Maquet Magnus operating table was tilted about 10-15 degrees to the right side to facilitate bilateral decompression of ligamentum flavum (Figures 2C-E). According to anesthesia records, invasive arterial blood pressure was monitored every 5 min and no systolic blood pressure dropped below 100 mmHg (Figure 2B).
case_images: Comparison of preoperative and postoperative MRI, red arrow indicates right L5 root on sagittal and axial planes. All images revealed no significant change or foraminal stenosis of right L5 root. (A) Sagittal plane, (B) axial plane at L4-5 level of preoperative MRI; (C) sagittal plane, (D) axial plane at L4-5 level of postoperative MRI.
case_images: fsurg-11-1329860-g003.jpg
case_images: PMC10894923_01_fsurg-11-1329860-g003.jpg
case_images: F3
case_images: To differentiate from L5 radiculopathy, often caused by disc bulging at L4/5 level or L5/S1 foraminal stenosis, pre- and post-operative lumbar spine MRI were thoroughly examined (Figure 3).