The patient came to the clinic
30-July-2006 with LBP and left sciatica for 2 months
with exacerbation of the sciatica the last week with positive cough
sign. MRI of the lumbar spine performed 30-July-2006 showed huge
extrusion of L4-5 disc with left up and downward migration with
bulging L5-S1 disc.
On examination: the patient had exaggerated
scoliotic stance with SLRS 50 degrees shooting to the left side and
5 degrees in the left side. She had hypalgesia of the left L5 and S1
territories with almost drop left foot and weak dorsiflexion right
foot and planterflexion left foot.
Left L4-5 hemiflavotomy with foraminotomy of the left L5 root was
performed and the extruded disc was removed in one piece lateral to
the axilla. The defect in the annulus fibrosis was medium and the
disc material during cleaning of disc space was relatively healthy,
for what minimal cleaning was attempted.
Prompt postoperative recovery.
consistency of the intradiscal material play a role in the limits of
cleaning. In case that the defect in the annulus fibrosis in minimal
or medium, it is preferable to limit intradiscal cleaning to the
intradiscal sequestrated material. If the material looking healthy,
then it is better not to violate it.