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03-MARCH-2008  SAEED MUHAMED SAEED AL-BLUSHY  73 YEARS  REDO AFTER FAILED RIGHT FORAMINAL DECOMPRESSION OF L3-4 DISC.

Anamnesis:

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The patient came to the clinic 01-March-2008 complaining of LBP and right sciatica down to the right knee for 7 months. He is using crutches for 13 years after performing bilateral total knee replacement in USA.

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MRI lumbar spine done 20-September-2007 showing extruded disc L3-4 with right foraminal occlusion, totally obliterating and compressing the running root.

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The patient performed locally in Bahrain right hemiflavotomy of L3-4 10 days after the MRI, without any benefit.

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MRI lumbar spine done 04-February-2008 showing the same compression at the mentioned level.

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On examination: the patient is limping and dragging his right leg and has scoliotic stance. SLRS was 60 degrees in the right and 80 degrees in the left with radiating pain to the right side of the loan and the right hip and down to the left knee.  The patient had weak dorsiflexion and planterflexion right foot 4/5 and hypalgesia right L3 territory.

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The patient was sent for CT-scan of the pelvis with pelvis X-ray to rule out other associated lesions. The performed investigations ruled out the presence of other causes of his problem.

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Laminectomy of L3 was done and using the image-intensifier the anatomical landmarks were identified. Foraminotomy of right L4 root was performed. The extruded disc was removed from the far-lateral position of the disc space of L3-4 and after intradiscal and extradiscal cleaning, the root was seen pushed up. All the compressive bony and soft tissues elements were removed, after what the root regained relax position. It was inspected until its emergence from the right foramen.

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Routine closure of the wound and smooth postoperative recovery with normalization of the power of the right foot.

Comments

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So as to perform adequate foraminotomy without causing instability, it is necessary to use high-speed drilling, to prevent the bony structures and eliminate all the compressive elements around the compressed root.

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According to the previous scar, the pathological process was more superior and it was necessary to go up 10 mm to find the emerging root and release it from proximal to distal. It was pushed up and far-lateral.

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The expected recurrence rate here is below average, since the disc space is shallow.

 

 


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