L5-S1 disc herniation
Describing a new syndrome in L5-S1 disc herniation: Sexual and sphincter dysfunction without pain and muscle weakness 1).
Another case about sildenafil treatment in neurogenic female sexual dysfunction caused by L5-S1 intervertebral disk rupture in 2007 2).
Classification
Clinical features
Diagnosis
Yilmaz et al. suggested that a proposed method “Yilmaz-Ilbay plantar flexion test” can serve as a useful, practical, and effective test to detect quantitative evaluation of plantar flexion in L5-S1 herniation 3).
Treatment
Case series
A total of 32 patients (average age: 49.4 years, range: 23-78) with L5-S1 disc herniations were included. The patient to be tested stood next to a table on which they could lean with their hands. The leg closer to the table was fully flexed at the knee, and the other foot was brought to maximum plantar flexion on the toes. At this point, a stopwatch was started to measure the time that passed until the muscles fatigued and the heel fell. The differences between the right and left plantar flexion times were noted. In addition, three different physicians graded muscle strength by using the classical “The Medical Research Council of the United Kingdom” method.
The time until fatigue in right and left plantar flexion was measured using the proposed method, and each test underwent a video recording. The Yilmaz-Ilbay plantar flexion test yielded the correct classification for all cases.
They suggest that the proposed method “Yilmaz-Ilbay plantar flexion test” can serve as a useful, practical, and effective test to detect quantitative evaluation of plantar flexion in L5-S1 herniation 4)
Case reports
A 72- year-old female patient was admitted to our outpatient clinic complaining of right leg pain for 6 months. A 4/5 motor paresis was observed on her right toe with a positive Lasegue test at 45°. On her magnetic resonance imaging (MRI), a L5-S1 disc herniation was detected. The patient was planned for percutaneous endoscopic interlaminar disc surgery. The extruded disc was adherent to the dura. During removal, a dural tear was observed. She was relieved of her right leg pain immediately after surgery, but after 30 min postoperatively, she complained of double vision with left abducens nerve paralysis. On cranial MRI, no abnormality could be observed. Intravenous fluids were administered and the paralysis resolved on the postoperative 24th hour. The patient was discharged from the hospital and did not show any complaints on her follow-ups. A 6th nerve palsy can be caused due to alterations of intracranial pressure or mechanic injury. We believe that the durotomy following removing of the disc fragment caused a rapid drainage of CSF, leading to intracranial hypotension and injury of the abducens nerve. Intracranial pressure should be monitored perioperatively and brisk deteriorations has to result in immediate finishing of the surgery to avoid further secondary damage 5).
A 35-year-old woman with a history of hypertension who successfully received microendoscopic L5-S1 lumbar discectomy for lumbar disc herniation at L5-S1 under general anesthesia. Six hours after surgery, she suffered from headache, nausea, visual disturbance, and seizures. Magnetic resonance imaging revealed vasogenic edema in the occipital lobe, and she was diagnosed with PRES. Prompt symptomatic treatment resulted in a full recovery at 3 days after surgery. Subsequently, we reviewed the literature pertaining to PRES following spine surgery. The review of the relevant literature on PRES following spine surgery identified 12 cases (male, n = 2; female, n = 10; average age, 59.5 years). Approximately 92% patients received multi-level decompressive laminectomy and/or fusion. This case and the review of the relevant literature suggest that even minimally invasive spine surgery in a young woman with specific characteristics (eg, hypertension) can cause PRES 6).
Case report about nucleus pulposus reabsorption of L5-S1 giant disc herniation 7)
Case reports from HGUA
Q11750
Right L5-S1 lumbar disc herniation in a a 31 year old female.
-DIAZEPAM 5MG
-Tapentadol RETARD 50MG 60 TABLETS OF PROLONGED RELEASE.
-PREGABALIN CAPSULES 75 MG.
Strength 3/5 to plantar flexion and eversion of the right foot. Hypoesthesia in right S1 territory. Gait possible but in antalgic position
Signs of degenerative disc dehydration of the L5-S1 disc only, presenting a posterior extruded lumbar disc herniation lateralized to the right with descending right S1 compression.