MINIMALLY INVASIVE APPROACH IN PATIENT WITH EXTRAFORAMINAL DISC HERNIATION

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.