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06-AUGUST-2008  ABDALLAH KAMAL AL-QAWASMEH  45 YEARS  HUGE CENTRAL DISC L4-5 WITH LEFT OLD AND FRESH RIGHT EXTRUSION.

Anamnesis:

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The patient came to the clinic 29-July-2008 complaining of LBP and right sciatica for 20 days. The patient had left sciatica 5 years ago.

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MRI done 13-July-2008 showed huge central extrusion of L4-5 with old left and fresh right sided extrusion with compression of both L5 roots.

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On examination: the patient has exaggerated scoliotic stance, limping with SLRS 20 degrees with pain in the right. There is weak dorsiflexion right foot 4/5.

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Bilateral L5 foraminotomy with bilateral flavotomy was performed. The soft right extrusion was attacked first lateral to the axilla and meticulous cleaning of the disc space of L4-5 was performed.

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The bony hard extrusion was attacked lateral to the left L5 root and it was removed and meticulous cleaning was performed from the left.

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Considering that bilateral cleaning was performed and the defect of the annulus fibrosis was considerably large, it was intentionally decided to widen the defect lateral to the right axilla in the annulus fibrosis, so as to minimize pain in case of future recurrence.

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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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The estimated recurrence rate in this case is around the average, because the disc space height is still not shallow.

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In case of bilateral cleaning, the defect in the annulus fibrosis is relatively wide. In such a case, it is preferable to extend the defect more far lateral, so as to ease the pain in case of future recurrence.

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