02/18/2026
Large L4–L5 Paracentral Disc Herniation & How’s its Fixed Minimally Invasive
The L4–L5 level is the most common location for lumbar disc herniations.
When the disc bulges or ruptures just off midline (paracentral), it usually compresses the L5 nerve root. That nerve travels down the leg and controls sensation over the top of the foot and strength lifting the foot upward.
Common symptoms include:
• Severe shooting leg pain
• Numbness over the top of the foot
• Weakness lifting the foot
• Pain worse with sitting or coughing
• Occasionally foot drop
When conservative treatment fails and symptoms persist or weakness develops, a minimally invasive laminotomy and microdiscectomy can relieve pressure on the nerve.
Through a small incision:
• Muscles are dilated, not cut
• A small portion of lamina is removed
• The nerve root is gently protected
• The herniated fragment is removed
The goal is simple: Free the nerve. Preserve everything else. No big whacks on the back!
All my patients walk the same day and are required to walk 2 miles throughout the day for rehab.
Leg pain often improves immediately.
This is not about making a big incision….it’s about making a precise one.
Dr. Joseph R. Blythe, DO
Board-Certified Orthopedic and Minimally Invasive Spine Surgeon
