History

The patient, aged 54-years, is an avid skier and mountain biker who presents with a sudden right foot drop after skiing. She had a transient left leg radiculopathy that improved with a bilateral L4-L5, L5-S1 transforaminal epidural steroid injection. However, persistent weakness in right ankle dorsiflexion has prevented her from returning to her activities. Her history includes degenerative scoliosis, which has been well-managed with nonoperative care. Previously (2012), she underwent right L4-L5 microdisectomy.

Diagnosis

Recurrent L4-L5 herniated nucleus pulposus with right foot drop.

Anteroposterior and lateral x-rays of the lumbar spine.

Flexion and extension x-rays of the lumbar spine.

Sagittal MRI denotes L4 and corresponding axial view of L4-L5.

Sagittal MRI denotes the L5 level and corresponding axial view of L5.

Selected Treatment

Right L4-L5 transforaminal endoscopic discectomy was performed.

Outcome

The patient reported she has, “practically no foot drop while walking.”