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26-JULY-2009 NADA MAHMOUD AL-ATRASH 60 YEARS
EXTRUDED DISC L3-4 WITH LEFT DOWNWARD MIGRATION.
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Anamnesis:
The patient came to the
clinic 22-July-2009 complaining of LBP with
left sciatica for 4 years with exacerbation the
last 10 days.
She has left blind eye with
keratitis since childhood. She is a known
diabetic for 6 months and hypertensive for 10
years.
MRI lumbar spine performed
19-July-2009 showing extruded disc L3-4 with
left downward migration. MRI of the brain done
14-July-2009 showing scattered old lacunar
infarctions.
On examination: the
patient is limping with
scoliotic stance, SLRS
was 90 degrees both
sides and
weak dorsi and planterflexion
left foot 3/5.
Using image-intensifier
the L3-4 level was
identified and
methylene-blue was used
to keep the tissue
marking. Left L3-4
hemiflavotomy with
extended exposure the
left L4 root was
performed inferiorly.
The downward migrating
big disc material was
removed in several
pieces lateral to the
axilla. Left sided
cleaning of the disc
space of L3-4 was
achieved. Routine
closure of the wound.
Smooth postoperative recovery
with improvement of the power of the left foot.
Comments
The expected recurrence in
this case is around 7% and PEEK nucleus
replacement sphere was not in favor, because of
osteoporotic bone.
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 .
