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08-JANUARY-2003 ZUHDIYEH ALI AL-RAMAHI 58 YEARS
RECURRENT EXTRUSION L4-5, L5-S1 WITH OSTEOMYELITIS.
Anamnesis
The patient came to the clinic 02-January-2003
complaining of LBP for 20 years , left sciatica
7 years, then exacerbation of left sciatica the
last 3 months. MRI lumbar performed
09-October-2002 showed extruded disc L4-5 and
L5-S1 for what discectomy both disci was
performed 16-October-2002 elsewhere. MRI lumbar
spine performed 14-December-2002 showing
recurrence of both disci with discitis and
osteomyelitis. She has hypertension for 4 years.
Has allergy to certain foods.
On examination: the patient in agonizing pain,
limping with exaggerated scoliotic stance. SLRS
was 70 degrees with pain right side and 60
degrees with more pain in the left. There is
drop left foot and weak planterflexion both feet
3/5 and dorsiflexion right foot 3/5.
The old incision refreshed and
the puss material during scarolysis was sent for
CXS. Neurolysis of the left L5 and S1 roots with
foraminotomy to both. The extruded disc were removed
lateral to the axilla and left sided intradiscal
cleaning of L4-5 and L5-S1 was performed with the
material sent for CXS. 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 both
feet improved. She was sent to the ward.
Follow Up
The patient came to the clinic 23-January-2003
with clean wound and still complaining of LBP
with left sciatica. SLRS still 60 degrees with
less pain with weak dorsiflexion left foot 4/5
with hypalgesia left S1 root. The patient was
advised to keep in long term antibiotics
with pain-killers and repeat ESR and CRP
monthly.
The patient then came 30-March-2003 with SLRS 90
degrees left side, with some improvement of the
power of dorsiflexion left foot and no
hypalgesia.
The patient then came 01-March-2006 complaining
of neck and right shoulder pain for 2 months and
numbness right median nerve distribution. Now
diabetic for 6 months. There is weak grip,
extension right hand and right triceps muscle.
Even the patient is not complaining of Left
sciatica but the weak dorsiflexion left foot persisted.
She was sent for MRI cervical spine, but she
disappeared.
Comments
The recurrence rate in this case still
ranking around 14%.
The sciatic pain during inflammatory process
is more painful in comparison to usual recurrence and needs
long-term antibiotic therapy.
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