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The patient came to the clinic 18-June-2006 complaining of LBP for 4
months with left sciatica. MRI lumbar spine performed 12-June-2006
showed huge extruded disc L5-S1 with left downward migration. On
examination: SLRS was 75 degrees in the left with hypalgesia left L5
and S1 territories with weak dorsi and planterflexion left foot. The
patient was given pain-killers and advised for surgery. The
patient during the early morning was urging for surgery, for what,
she was admitted urgently and operated. Left L5-S1 hemiflavotomy was
performed and the extrusion was removed from under the axilla.
Meticulous cleaning of the disc space was achieved from the point of
extrusion. The left S1 root was shifted lateral and all compressive
elements were removed after what the root became relax and
foraminotomy of left S1 root was performed and check of the canal
was done.
Smooth postoperative recovery.
Comments: 1. The rule of
removal of the extrusion and minimal cleaning of the disc space is
not possible all the time. In this case, it was necessary to perform
meticulous cleaning, because the defect in the annulus fibrosis was
big and it was logical to remove as much as possible to decrease the
recurrence rate. 2. Good inspection of all concerned roots in the
territory must be performed. The left S1 root was at the start of
the operation was hidden lateral to the extrusion. It was identified
and decompressed after removal of the extrusion. |
