Clinical Course
The patient is a 25 year old female with a 3 month history of low back pain. The onset of the symptoms were insidious and on initial presentation she had no leg pain, no leg numbness, no leg weakness. The mechanisms that aggravated her back pain were sitting and bending foward and twisting. Her initial physical exam revealed restriction of motion when she bent forward with increased back pain and when she lay on her back and her right leg was raised with her knee straight (straight leg raising) she experienced low back pain and some pain the her right buttock.
Her initial treatment consisted of Non-steroidal anti-inflammatory medicines and physical therapy to strengthen her back. She responded well enough to play golf and snowboard.
10 months after her original office visit she returned complaining of pain in her right leg which began in her buttock and ran down the back of her thigh into the back of her calf. She was unable to play golf and her activities were painful and limited: sitting was intolerable (driving a car) and her pain was interfering with her life activities: work and sports. Her examination that day revealed pain in her leg as she described it when her right leg was lifted while she was lying on her back. Her leg could only be raised 30 degrees from the bed before she experienced severe leg pain in her thigh and calf. She could only bend forward slightly when standing without severe leg pain.

Diagnostic Tests
An Magnetic Resonance Imaging study was ordered and reviewed with the patient. The test revealed a large herniated disc between the 4th and 5th lumbar vertebrae on the right side.

Decision
Because of her leg pain limiting her activities and the intensity of her daily pain, she chose to have surgery. The MicoEndoscopic Surgery was the surgery of choice for her because she wanted Minimally Invasive Surgery and the quickest return to her normal life.

Surgical Treatment
MicroEndoscopic Technique combines utilizing fluroscopy to localize the appropriate level and television to visualize the image from the MicroEndoscopic camera. The MicroEndosocopic Surgery is performed while looking at the television view.
She had surgery performed and experienced immediate relief of her leg pain. The incision was 16 mm and she was able to quickly recover, rehabilitate her back with physical therapy and return to her usual working life as an avid golfer, student and bartender.

Surgeon's Comment
This is a rather typical scenario: a patient with back pain who eventually herniates the disc and develops leg pain. The mechanical nature of her leg pain was demonstrated by the straight leg raising test (raising her leg with her knee straight while the patient lays on her back). She also had an MRI scan with a disc herniation which explained the distribution of her pain (the correct side and the correct nerve to give her the symptoms she experienced). This relationship between her complaint of leg pain, the straight leg raising test and the MRI scan formed the basis for linking her symptoms, physical exam, and the diagnostic study together to provide the criteria for successful surgery.