The patient came to the clinic with agonizing pain with
sciatica and severe weak dorsi and planterflexion of the right foot
with SLRS right 10 degrees. She was sent for MRI lumbar spine, confirming the presence of
huge prolapsed disc L4-5 right side and small bulge L5-S1.
The patient was operated: Right L4-5 hemiflavotomy was performed,
and the extruded disc was removed lateral to the axilla and minimal
cleaning of the disc space of L4-5 was done. Check of the foramen of
left L5 root was negative for presence of compression. Foraminotomy
right L5 root was achieved.
During the first steps
of surgery, overmobility of the L5 lamina was noted. Inspection for
isthmolysis or fatigue fractures were negative. No evidence of
spondylolisthesis in the morphological studies were noted. It was
decided to achieve good ample for the root in case that the patient
in the up-right position could suffer compression or irritation of
1. As several times mentioned the PLD rarely coming alone, some
associated pathologic findings could be noticed before during and
even after surgery. It is hard to predict the importance of these
findings, but they must be considered during surgery and the guess
of the surgeon to make the appropriate decision, how to deal with
such situation, as in this case with overmobility. Only wide
foraminotomy of the right L5 root was done by drilling to preserve
the bony alignments.