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14-JUNE-2010 SALMA RASHEED SALEH 52 YEARS
RECURRENT PLD L4-5 LEFT SIDE.
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Anamnesis
The
patient came
to the clinic13-June-2010 complaining of LBP
with left sciatica for 45 days with exacerbation
of both the last 10 days.
The patient was
operated by me 1996 for PLD L4-5 for left
sciatica. and was doing well. She was also
diagnosed and treated by me 2 years later for
MS.
MRI of the lumbar
spine performed 13-June-2010 showed recurrence
of disc of L4-5 with complete obliteration of
the left L5 root.
On examination;
the patient on agonizing pain urging for
surgery. She cannot stand for evaluation of
scoliotic stance. SLRS was 40 degrees in the
left with pain. There is weak dorsiflexion left
foot -4/5.
The upper part of the old incision was refreshed
and scarolysis of the left L5 root was achieved.
The extruded fragments were removed lateral to
the axilla after what the root became lax and
free. Further cleaning of the disc space was
done from the left side.
Routine closure of the wound and smooth postoperative recovery with
improvement of the power of the left foot.
Comments
Recurrence of the lumbar disc
still consisting a major problem, which up to
now is not resolved. It could happen even after
20-30 years after surgery as in this case.
The expected re-recurrence in
this case is minimal because the disc space is
shallow.
PEEK is no more adopted by us
because it has many problems and causing with
all patients reactionary osteomyelitic changes
of the adjacent vertebrae, which needs long-term
treatment and sometimes removal of the sphere.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
