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23-SEPTEMBER-2008  SUHAILA SALEM AL-KHATEEB  46 YEARS  HUGE EXTRUDED DISC L4-5 CENTRAL MORE TO THE LEFT.

Anamnesis:

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The patient came to the clinic 11-September-2008 complaining of LBP for 15 years with left sciatica. Exacerbation the last two weeks of the left sciatica.

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The patient was treated for Ca breast 5 years ago.

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On examination: the patient in agonizing pain. Limping with scoliotic stance  with pain left side. She had almost drop left foot and weak planterflexion left foot 4/5.

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MRI performed 13-September-2008 showed extruded disc of L4-5 with left downward migration and bulge L5-S1.

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Left hemiflavotomy of L4-5 was done and foraminotomy of left L5 root was achieved.  The extruded with down migrating piece was removed in several fragments lateral to the axilla. Considering that the disc space still high and the annulus fibrosis is not hard and there is defect at the annulus, it was decided to clean the L4-5 disc space meticulously from the left side.

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The defect of the annulus fibrosis was wide, for what further cleaning was performed.

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Routine closure of the wound and smooth postoperative recovery.

Comments

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The patient had  still not shallow disc space, for what the estimated recurrence rate could be more than 7%.

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