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27-DECEMBER-2010 SAWSAN ABDEL-RAHEEM AWAWDEH 40
YEARS HUGE EXTRUDED DISC L5-S1 WITH LEFT DOWNWARD MIGRATION.
Anamnesis
The patient
came to the clinic 27-December-2010 complaining
of agonizing left sciatica for three days,
depriving her sleep during this period.
MRI of the
lumbar spine performed 27-December-2010 showing
huge extruded disc L5-S1 with left downward
migration.
On
examination: The patient is unable to
stand to evaluate her stance and walking. She
could sleep with difficulty supine to evaluate
the SLRS which was 70 degrees with pain in the
left side. There is weak dorsiflexion 3/5 of the
left foot. There is numbness of the entire left
foot, but with preserved sensation.
Foraminotomy of left S1 was performed and
subaxillary removal of the huge extrusion was
achieved. The disc fragments was hard and with
sharp edges. The axilla was then shifted
medially and intradiscal cleaning of L5-S1 was
performed. The epidural fat was maximally
preserved to prevent scar formation.
Routine
closure of the wound. Smooth postoperative
recovery with normalization of the power of the
left foot and disappearance of left sciatica.
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Comments
The patient has very huge extruded disc
L5-S1 with downward migration. Conservative
treatment will not succeed.
The recurrence rate in this case is below
7% because the disc space is relatively shallow.
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 .
