Connection between herniated nucleus pulposus and nerve roots in far lateral lumbar disc herniation

AbstractBackground: Far lateral lumbar disc herniation (FLLDH) compresses the nerve root or dorsal ganglion outside the spinal canal at the same level as the herniation, producing severe pain on the anterolateral thigh. The pain is so severe that many patients cannot even walk. The severity of pain is attributed not only to compression, but also some chemical inflammation. Objective: To report a case of FLLDH whose nerve root was depicted during discography.Case report: A 55-year-old-man presented with severe pain from the left buttock to the left anterolateral thigh and leg. Abnormal shadowing suggested left FLLDH at the L5/S1 level on magnetic resonance imaging. During discography, a shadow suggestive of the left fifth lumbar nerve sheath was depicted. Comparing the computed tomography (CT) after discography and CT after rootgraphy, the root sheath-like shadow on discography was confirmed as the nerve root sheath. After nerve root block, pain decreased and the patient was discharged. Conclusions: The co...