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The
patient came
to the clinic 20-August-2007 with history of
convulsions for 2 years and LBP for 20 years
with left sciatica for 3 years down to left L5
root. |
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The patient was put
in Depakine chrono twice daily and MRI of the
brain performed 29-January-2008 showed lacunar
infarction periventricular more in the left. |
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The patient then
came 06-August-2008 with neck pain and weak
extension right hand the the right triceps
muscle. MRI cervical spine performed
11-August-2008 showing extruded disc C4-5
and 5-6. He was advised to keep in conservative
treatment. |
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The patient then
came 09-October-2010 complaining of LBP with
left sciatica with severe exacerbation the last
15 days. MRI lumbar spine performed the same day
showing extruded disc L4-5 with left foraminal
occlusion. The piece was medium in size and gray
in color. |
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On examination: The
patient is limping with exaggerated scoliotic
stance. SLRS was 60 degrees with pain in the
left. There is weak dorsiflexion -3/5 and
planterflexion -4/5 of the left foot. The
patient was advised to keep in bed and to try
conservative treatment and in the case that no
improvement surgery to be considered. The
patient then further deteriorated and urged for
surgery. |
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Left L4-5 hemiflavotomy was performed. The soft
tissues were watery and minimal bleeding during
dissection was noted, mostly due to cardiac
problems. Left L5 root foraminotomy. The
extruded downward migrating disc was removed
lateral to the axilla. Left sided cleaning L4-5
disc space. The compressed tissues were lacking
the epidural fat. After decompression the root
became lax. |
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Routine closure of
the wound and smooth postoperative recovery
disappearance of left sciatica and normalization
of the power of the left foot. |
