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Multigen RF lesion generator .

 

08-APRIL-2008  JALILEH RUSHDY RWESHED  70 YEARS  EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION. RESIDUAL AFTER DECOMPRESSIVE LAMINECTOMY L3-4-5 17 YEARS AGO FOR LCS.

Anamnesis:

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The patient came to the clinic 02-April-2008 complaining of LBP for 20 days with left sciatica for 10 days with numbness and pain left L5 territory.

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The patient was operated by me 17 years ago for LCS L3-4, L4-5 and L5-S1.

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MRI of the lumbar spine performed 21-March-2008 showed extruded disc L4-4 with left downward migration with foraminal occlusion.

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On examination: the patient was limping with scoliotic stance. SLRS was 70 degrees in the right and 15 degrees in the left with weak dorsi and planterflexion left foot 4/5.

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Through the previous incision the upper bony edge of the sacrum was identified and the scar was removed above the facets of left L4-5 and L5-S1. To avoid massive dissection of the scar, the image-intensifier was used to perform neurolysis of the left L5 root and foraminotomy of this root was achieved. The downward migrating disc material was removed in several pieces and the disc space of L4-5 was cleaned from the left side.

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Routine closure of the wound with smooth postoperative recovery.

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Moderate improvement of the power of the left foot.

Comments

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In the presence of scars from previous surgery such in this case, it is preferable to use the image-intensifier to minimize the area of dissection.

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