Double-crash on L4 nerve root at different segments [Farklı disk seviyelerinden L4 kökünün Kombine kompresyonu (Double-crash)]

Although lumbar disc herniation is one of the most common pathologies in neurosurgery,each patient has different challenges. with multiple level disc herniation,decision making process gets more complicated. here we report a unique case with multiple level herniation that both compress the same nerve root. 62 year-old woman admitted with left leg pain and her neurological examination showed weakness on quadriceps femoris and reduced patellar reflex. imaging studies show l3-4 paramedian and l4-5 far-lateral disc herniation,both of which compress left l4 root causing a double-crash. she was operated with a median incision conformed for l3-4 standard discectomy and extended slightly caudally. this approach permitted l3-4 hemilaminectomy and l4-5 extra foraminal approaches. patients are rarely symptomatic from multiple level disc herniation and multiple level discectomy should be exceptionally rare. a thorough neurologic examination is vital for multiple level disc herniation and usually point an individual level that causes symptoms. this patient is a unique example that needs multiple level discectomy although her neurologic examination shows compression on a single nerve root. a midline incision slightly extended caudally is sufficient to expose both levels in a patient with double-crash. © 2016,ege university press. all rights reserved.