MINIMALLY INVASIVE APPROACH IN PATIENT WITH EXTRAFORAMINAL DISC HERNIATION
Date Issued
2023-04-07
Author(s)
Kostova, Masha
Jovanoska, Ivona
Nancheva, Andrea
Dungevski, Gjorgi
Abstract
Objective: The aim of our study was to evaluate the history, treatment and clinical outcome
of a patient with low back pain and radiculopathy caused by extraforaminar disck herniation,
after a minimally invasive procedure (PRT) periradicular therapy and physical therapy in
order for educational purposes.
Clinical features: A 48-year-old patient without comorbidities was presented with 3-week
history of lumbar pain with irradiation to the left lower extremity. The patient had difficulty
sitting and standing with antalgic movement without being able to assume an upright
position.. The pain was intensified by lateral movements dominant left and positioning
backwards with propagation to the left side and hip. Dominant symptom was radicular pain
with paresis and hypesthesia of the affected dermatoma of lower limb. The diagnosis was
confirmed by magnetic resonance imaging with showed exoforaminar disc herniation on the
level L4-L5.
Intervention and outcome: Advantages of PRT are: minimal invasive procedure, CT guided
intervention for exact and precise delivery of the medications, low risk in damage of
important local anatomical structures, short recovery time, easy approach and low cost for
patient and for the medical institution, respectively. In our study, CT Siemens 16 slice was
used for the intervention. The patient was treated with lumbar epidural corticosteroid
application and physical therapy. Physical therapy included self-traction and strengthening
exercises. Functional status was measured using a Modified Oswestry Questionnaire and
numerical pain assessment scale VAS scale. Initially, before intervention, functional status
was assessed at 68%, with pain 8/10. After treatment, functional status was 4% and pain was
assessed as 1/10.
Conclusion: Multidisciplinary approach is needed in patients with extraforaminal disc
herniation for better results. In our case study, PRT demonstrated a significant role in treating
our patient. As a result of the treatment significant reduction of pain and improvement of
functional status was observed. The patient returned to normal life habits and activities in a
very short time, which was primary goal.
of a patient with low back pain and radiculopathy caused by extraforaminar disck herniation,
after a minimally invasive procedure (PRT) periradicular therapy and physical therapy in
order for educational purposes.
Clinical features: A 48-year-old patient without comorbidities was presented with 3-week
history of lumbar pain with irradiation to the left lower extremity. The patient had difficulty
sitting and standing with antalgic movement without being able to assume an upright
position.. The pain was intensified by lateral movements dominant left and positioning
backwards with propagation to the left side and hip. Dominant symptom was radicular pain
with paresis and hypesthesia of the affected dermatoma of lower limb. The diagnosis was
confirmed by magnetic resonance imaging with showed exoforaminar disc herniation on the
level L4-L5.
Intervention and outcome: Advantages of PRT are: minimal invasive procedure, CT guided
intervention for exact and precise delivery of the medications, low risk in damage of
important local anatomical structures, short recovery time, easy approach and low cost for
patient and for the medical institution, respectively. In our study, CT Siemens 16 slice was
used for the intervention. The patient was treated with lumbar epidural corticosteroid
application and physical therapy. Physical therapy included self-traction and strengthening
exercises. Functional status was measured using a Modified Oswestry Questionnaire and
numerical pain assessment scale VAS scale. Initially, before intervention, functional status
was assessed at 68%, with pain 8/10. After treatment, functional status was 4% and pain was
assessed as 1/10.
Conclusion: Multidisciplinary approach is needed in patients with extraforaminal disc
herniation for better results. In our case study, PRT demonstrated a significant role in treating
our patient. As a result of the treatment significant reduction of pain and improvement of
functional status was observed. The patient returned to normal life habits and activities in a
very short time, which was primary goal.
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