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15-JANUARY-2003 AMJAD ALI AL-KAYYALI 42 YEARS
EXTRUDED DISC L4-5 WITH RIGHT DOWNWARD MIGRATION.
Anamnesis
The patient came to the clinic 07-January-2001
complaining of LBP for 10 days with right
sciatica. MRI lumbar spine done at that time
showed small extruded disc L4-5 and conservative
treatment was advised. The patient then came
12-January-2003 telling that the LBP with right
sciatica exacerbated the last 2 weeks.
On examination: the patient in agonizing pain,
limping with exaggerated scoliotic stance. SLRS
was 40
degrees with pain in the right. There is weak
dorsiflexion right foot 3/5 with hypalgesia right
L5 and S1 roots territories.
The patient was sent for investigation and MRI
lumbar spine showed broad based extrusion L4-5
with left downward migrating extrusion.
Right L4-5 hemiflavotomy with
right
L5 foraminotomy. The extruded disc was removed
lateral to the axilla and right sided intradiscal
cleaning L4-5 disc space. The downward migrating
piece was also removed. Left side hemiflavotomy with
left L5 foraminotomy and bilateral cleaning of the
disc space was achieved. The patient was put in
Reverse Trendelenburg position with Valsalva
maneuver and hyperventilation. No CSF leak. Routine closure of
the wound
Smooth postoperative recovery.
The radicular pain decreased and the power of right
foot normalized. He was sent to the ward.
Follow Up
The patient came to the clinic 25-January-2003
with clean wound with SLRS 90 degrees without
pain with no sensory, nor motor deficit.
Comments
The recurrence rate in this case still
ranking around 7% because the disc space is not completely
collapsed.
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Notice: Head injuries and very urgent surgeries are also
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