title: Management of an unusual sciatica.
abstract: Extraforaminal entrapment of the L5 nerve root is uncommon, and its management can sometimes be very challenging.
  
  
  
  We present the case of a 57-year-old female, complaining of a sciatica in her left leg, for 3 years, with no response to any kind of conservative treatment. MRI and CT scan revealed the presence of a large L5S1 strictly lateral osteophyte compressing the left L5 root in its extraforaminal path.
  
  
  
  The patient underwent a left anterior retroperitoneal approach with assistance from a vascular surgeon given the very close relation between the osteophyte and the left common iliac vein, lying just on top of it, osteophyte was removed in one piece with the use of an osteotome after retraction of the vessels. The patient progressively recovered from her left sciatic pain with a satisfactory clinical result at 1 year.
  
  
  
  Literature is sparse on the treatment of extraforaminal entrapment of the L5 nerve root; the current case shows a successful treatment strategy with the use of an anterior approach for direct vision of the lesion and good control of the vessels.
authors.affiliation: Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O. Box 84400, Riyadh, 11671, Saudi Arabia. anouar.bourghli@gmail.com.
authors.forename: Anouar
authors.initials: A
authors.lastname: Bourghli
authors.affiliation: Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O. Box 84400, Riyadh, 11671, Saudi Arabia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Chaballout
authors.affiliation: Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Obeid
authors.affiliation: Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Boissiere
authors.affiliation: Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Vital
authors.affiliation: Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O. Box 84400, Riyadh, 11671, Saudi Arabia.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Khoury
mesh_terms: D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000294:innervation; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000601:surgery*; D054850:Osteophyte / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012585:Sciatica / Q000209:etiology / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Extraforaminal entrapment; L5 root; L5S1 osteophyte; Retroperitoneal approach