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07-SEPTEMBER-2008  DR. AWNI MUHAMED AL-BASHIR  52 YEARS  EXTRUDED DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.

Anamnesis:

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The patient started to complain of agonizing right sciatica for one day prior to admission 04-September-2008. MRI performed 03-September-2008 showed an extruded disc L5-S1 with right downward migration.

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On examination: he has hyperlipedimea and hypertension with high K level with some parameters, which required correction before surgery. He had weak dorsiflexion right foot 4/5 and hypalgesia right S1 territory.

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Right S1 root foraminotomy was performed and partial flavotomy was achieved. The epidural fat was rubbery at the disc level and using image-intensifier the shallow disc space of L5-S1 was identified.

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It was impossible to remove the extruded disc lateral to the axilla and the extrusion was severely compressing the nerve. It was necessary to go down and extend the foraminotomy and to attack the far migrating disc material under the axilla. It came in several pieces, after what the root became relax.

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Inspection of the disc space, revealed that the disc space is very shallow and there is tiny defect under the annulus fibrosis. Taking these data in mind, it was decided not to violate the disc space of L5-S1 to minimize the estimated postoperative recurrence.

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Routine closure of the wound and smooth postoperative recovery.

Comments

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The patient had very shallow disc space of L5-S1 with tiny defect of the annulus fibrosis. Leaving the disc space untouched, will yield better postoperative outcome with less expected postoperative recurrence rate.

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The estimated recurrence rate in this case is around zero.

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