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11-MARCH-2008 RAED KHADER HUSSEIN 38 YEARS
HUGE CENTRAL EXTRUSION L4-5 WITH DOWNWARD MIGRATION MORE THE RIGHT.
Anamnesis:
The patient came to the
clinic 09-March-2008 complaining of LBP for 5
years with left sciatica. He improved, then the
last 2 months got exacerbation of bilateral
sciatica more the left. He was walking with
difficulty.
On examination: he had
exaggerated scoliotic stance with SLRS 45
degrees with pain both sides. Weak dorsiflexion
both feet, more the left 3/5.
MRI lumbar spine performed
05-March-2008 showing huge PLD L4-5 with
central and downward migration, more to the
right.
Under image-intensifier,
because he had lumbarized S1, the level was
identified, and bilateral flavotomy L4-5 with
bilateral foraminotomy both L5 roots was done.
Cleaning of the disc space was performed from
the right, then from the left. The major
extruded disc then came in one piece from the
left side.
Routine closure of the wound
with smooth postoperative recovery.
Immediate recovery of the
power of both feet.
Comments
Bilateral meticulous cleaning
of the disc space is not a preferable procedure,
because, it could increase the stress at the
facet joints with subsequent long postoperative
period.
In this case it was necessary
to do this so as to decrease the rate of
recurrence.
