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02-MARCH-2009  MUTAZ BASEM AL-TWAL  22 YEARS  HUGE EXTRUDED DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.

Anamnesis:

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The patient came to the clinic 23-February-2009 complaining of LBP for one year with severe right sciatica and exacerbation of right sciatica the last month.

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MRI lumbar spine performed 01-December-2008 showing extruded disc L5-S1 with right downward migration.

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On examination: the patient is limping with mild scoliotic stance. SLRS was 25 degrees in the right with absent AJ with weak right foot 4/5 in dorsi and planterflexion.

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MRI performed 23-February-2009 showing very large extruded disc L5-S1 more to the right bigger than before.

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Foraminotomy of the right S1 root was performed and the sequestrated disc material was removed in one piece lateral to the axilla. Inspection of the annulus fibrosis revealed a very small defect for what using tiny instruments, the remnants of the extruded disc were removed. The epidural fat was transferred to the root to minimize the postoperative adhesions. Routine closure of the wound after inspection for CSF leak, which was negative.

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Smooth postoperative recovery.

Comments

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Recurrence in this case must be below the average, because the defect in the annulus fibrosis was minimal and the disc space height is also small.

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