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05-NOVEMBER-2008  MUHANAD MUHAMED SHOMALY  33 YEARS  HUGE EXTRUDED DISC L5-S1 WITH LEFT DOWNWARD MIGRATION.

Anamnesis:

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The patient came to the clinic 03-November-2003 complaining of LBP for 4 years with intermittent course.  Left sciatica for 6 months.

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MRI lumbar spine performed 31-October-2008 showed huge extruded disc L5-S1  with left downward migration.

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On examination: the patient is limping with exaggerated scoliotic stance, with SLRS 45 degrees in left side with pain and weak dorsiflexion left foot -4/5 and hypalgesia left S1 territory.

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Partial flavotomy L5-S1 left side with foraminotomy left S1 root was performed. The downward migrating disc material was removed under the axilla. There was anomalous anatomical variation, that the left S1 was originating high and pushed lateral and the left S2 root also originating high and pushed medially. The disc space of L5-S1 was cleaned meticulously from the left.

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Smooth recovery with prompt improvement of the power of the left foot.

Comments

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The patient had anomalous anatomical structures, that the surgeon must pay attention during surgery.

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The estimated recurrence rate in this case is around 7% since the disc space height is still not shallow.

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[2008] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved