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09-NIVEMBER-2008  MAHER AHMAD ABDALLAH  38 YEARS  HUGE CENTRAL EXTRUDED DISC L5-S1 MORE TO THE LEFT.

Anamnesis:

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The patient came to the clinic 08-November-2008 complaining of LBP for 2 months.  Left sciatica 2 weeks after that.

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MRI lumbar spine performed 10-September-2008 showed huge extruded disc L5-S1  central more to the left.

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On examination: the patient is limping with exaggerated scoliotic stance, with SLRS 20 degrees in left side with pain and weak dorsiflexion left foot 3/5 and planterflexion 4/5.

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Partial flavotomy L5-S1 left side with foraminotomy left S1 root was performed. The extruded disc was so sticky, that it was necessary to perform intradiscal cleaning of L5-S1 space, after what slight relaxation of the dura was achieved. The extruded disc was then removed lateral to the axilla. It was rubbery in consistency. The root became lax and further cleaning of the disc space was performed from the left side.

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Smooth recovery with prompt improvement of the power of the left foot.

Comments

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The patient had a rubbery extrusion, making it difficult to remove it directly. It was necessary to decompress the intradiscal cavity to obtain some relaxation to prevent traction injury to the already compressed nerve.

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The estimated recurrence rate in this case is around 7% since the disc space height is still not shallow.

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