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04-AUGUST-2008  MUHAMED ADNAN SHEHADEH  69 YEARS  HUGE EXTRUDED DISC L3-4 WITH LEFT DOWNWARD MIGRATION.

Anamnesis:

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The patient came to the clinic 12-January-1999 complaining of LBP with without sciatica for 5 years. MRI of the lumbar spine done 20-November-1998 showed extruded disc L3-4. He had prostate hypertrophy in cardura for 2 years.

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On examination at that time: he had exaggerated scoliotic stance with weak dorsiflexion left foot 4/5. The patient was treated conservatively.

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The patient then came 02-December-2003 with exacerbation of LBP without sciatica. His clinical status was the same as before and the MRI performed 13-November-2003 was the same as before. The patient was treated conservatively.

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The patient then came 16-July-2008 complaining of severe left sciatica for the last three days.

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On examination: the patient in agonizing pain with exaggerated scoliotic stance with SLRS 75 degrees in the left with pain with weak dorsiflexion right foot -4/5.

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MRI of the lumbar spine was performed 15-July-2008 showing huge PLD L3-4 with left downward migration.

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Using image-intensifier, the L3-4 level was identified and left L3-4 hemiflavotomy and left L4 foraminotomy was done. The epidural fat was missing at the compressed parts and the root was severely compressed. The downward migrating piece was removed lateral to the axilla in two separate pieces, after what the root became lax. Meticulous cleaning of the disc apace was performed from the left side.

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Routine closure of the wound with normalization of the power of the left foot.

Comments

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The patient came several times over  10 years. He was treated conservatively. But the last time when the extrusion became huge with downward migration, surgery was the only solution.

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Meticulous cleaning of the disc space could lower the estimated incidence of recurrence rate.

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