title: Far caudally migrated extraforaminal lumbosacral disc herniation treated by a microsurgical lateral extraforaminal transmuscular approach: case report.
abstract: A 33-year-old man presented with moderate low-back pain and L-5 radiculopathy that progressed to severe paresis of L-5. On initial imaging, a corresponding spinal lesion was overlooked. Further CT and contrast-enhanced MRI demonstrated a presacral mass along the L-5 root far extraforaminally. A herniated disc was suspected, but with standard imaging a schwannoma could not be ruled out. The presacral L-5 root was explored via a microsurgical lateral extraforaminal transmuscular approach. To the best of the authors' knowledge, there have been no reports of sequestered extraforaminal lumbosacral disc herniations that herniated into the presacral region.
authors.affiliation: Department of Neurosurgery and.
authors.forename: Anja
authors.initials: A
authors.lastname: Tschugg
authors.affiliation: Department of Trauma Surgery, Hospital Kufstein, Austria.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Tschugg
authors.affiliation: Department of Neurosurgery and.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Hartmann
authors.affiliation: Department of Neuroradiology, Medical University of Innsbruck; and.
authors.forename: Paul
authors.initials: P
authors.lastname: Rhomberg
authors.affiliation: Department of Neurosurgery and.
authors.forename: Claudius
authors.initials: C
authors.lastname: Thomé
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods*; D011843:Radiculopathy / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: EFDH = extraforaminal disc herniation; VAS = visual analog scale; extraforaminal disc herniation; extraforaminal transmuscular approach; far-lateral disc herniation; far-out syndrome; lumbar; sequestrectomy