[L5-S1 herniated disk migrated to the anterior part of the right sacral wing with compression of the right lumbosacral roots].
OBJECTIVE
The goal of this study was to report an exceptional case of far lateral and anterior disc herniation at L5-S1 level.


METHODS
A 47 year-old man presented a right L5 radicular pain with motor deficit of tibialis anterior and extensor hallucis longus resisting to medical management. Standard X-rays showed a degenerative process of L5-S1 disc. The CT scan was at first considered as normal. The myelogram was normal. A second study of the CT scan showed an opacity next to the L5 right root in front of the sacral wing. A discography combined with CT scan was then performed showing the migrated herniated disc from L5-S1 to the anterior part of the right sacral wing in contact with L5 root.


RESULTS
Surgery was performed by transperitoneal approach and needed a difficult dissection of hypogastric vessels. The herniated disc was found behind the L5 root. A L5-S1 disc excision and arthrodesis with iliac grafts were performed. The result has been very good with relief of the pain and recovery of the palsy within a month.


CONCLUSIONS
The lecture of a CT scan should include the far extraforaminal zone if there is no compression in the spinal canal. Such an anterior migration of an herniated disc has not been already described as far as we know.
Perves
A
A
Clinique du Château de La Maye, Versailles.
Morvan
G
G
D017586:Diskectomy / Q000379:methods*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000601:surgery; D008159:Lumbar Vertebrae; D008160:Lumbosacral Plexus; D008297:Male; D009408:Nerve Compression Syndromes / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed