Direct Endoscopic Visualization of Gas Release in a Lumbar Disc Herniation: A Case Report.

INTRODUCTION: Gas within a degenerated lumbar disc is common on computed tomography (CT), but a gas-filled disc herniation producing radiculopathy is uncommon. Recognition usually depends on CT rather than magnetic resonance imaging (MRI). Gas-containing disc herniation produces symptoms through mass effect rather than extrusion of disc material. CASE REPORT: A 62- year-old man presented with chronic right S1 radicular pain, sensory loss, reduced Achilles reflex, and weakness of the gastrocnemius. Imaging showed severe degeneration at L5-S1 with a lesion containing intradiscal gas. Endoscopic inspection demonstrated a tense diverticular outpouching of the disc compressing the descending nerve root. Puncture of the lesion released gas under direct vision, followed by removal of residual pathology. Symptoms improved immediately and remained improved at review. CONCLUSION: CT is the most reliable modality for detecting intradiscal gas and should be carefully reviewed when symptoms and MRI findings do not align. Gas-filled disc herniation should be included in the differential diagnosis of lumbar radiculopathy when CT demonstrates intradiscal gas adjacent to a nerve root. Endoscopic decompression provides definitive diagnosis and effective treatment.