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08-JANUARY-2003 RAIDA ABDEL-KAREEM BARHAM 32 YEARS
EXTRUDED DISC L4-5 WITH LEFT UPWARD MIGRATION.
Anamnesis
The patient came to the clinic 29-December-2002
complaining of LBP for 10 years with bilateral
sciatica. The last 20 days exacerbation of left sciatica
down to the territory of L5 with numbness and
weak left foot. The patient has sarccoidosis of
the lung in Imuran and cortisone. MRI lumbar performed
17-December-2002 showed extruded disc L4-5 with
left upward migration.
On examination: the patient in agonizing pain,
limping with exaggerated scoliotic stance. SLRS
was 70 degrees with pain right side and 25
degrees with more pain in the left. There is
weak dorsiflexion left foot 3/5 with hypalgesia
left L5 and S1 roots territories. The patient is
asked to stop Imuran for at least 1 week before
surgery and 2 weeks after surgery.
Left L4-5 hemiflavotomy with left
L5 foraminotomy. The extruded disc was removed
lateral to the axilla and left sided intradiscal
cleaning L4-5 disc space. 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 left
foot improved. She was sent to the ward.
Follow Up
The patient came to the clinic 20-January-2003
with clean wound with SLRS 85 degrees without pain with
slight weak dorsiflexion left foot 4/5.
The patient then came 16-August-2003 telling
that the last month got left sciatica with SLRS 90
degrees left side, with no motor, nor sensory
deficit. She was sent for MRI lumbar, but she
did not perform it.
The patient then came 21-June-2006 complaining
of LBP with left sciatica for 2 weeks. MRI done
14-June-2004 showing very small fragment at the
left side of L4-5. Neurologically she was free.
Treated conservatively.
Comments
The recurrence rate in this case still
ranking around 7% because the disc space is not completely
collapsed.
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