Minimally invasive management for a giant lumbar intervertebral disc herniation: A case report, and literature review

INTRODUCTION AND IMPORTANCE: Low back pain and lower limb radiculopathy are some of the most common diagnoses in our neurosurgery department. Giant lumbar intervertebral disc herniation, are not a common find in our daily practice. Management for this kind of pathology is controversial. The quest for the best surgical approach is still a matter of debate. This case report intends to demonstrate the advantages of minimally invasive procedures. CASE PRESENTATION: 40-year-old female, diagnosed with giant lumbar L5-S1 disc herniation with localized lower back electric-type pain, 5/10 intensity in the visual analog scale (VAS) and an Oswestry Disability Index (ODI) score of 76 points, underwent minimally invasive surgery (MIS) with tubular retractor system. 6-month post-op, the patient referred no pain, and an ODI score of 4 points was obtained. CLINICAL DISCUSSION: There is no clear classification, regarding the lumbar intervertebral disc herniated content. We didn’t find any clear indications or contraindications regarding the relationship of the size of herniated disc content and surgical approach (MIS vs Open). We perform on average 175 spine cases per year and educational commitment with spine pathology is demonstrated with our spine fellowship since 3 years ago. CONCLUSION: We believe giant extruded regardless of migration, single-level intervertebral disc herniation, could be effectively and safely treated by MIS.