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08-AUGUST-2009  RUQAYA ALI AL-DBEYH  40 YEARS  CENTRAL EXTRUDED DISC L4-5 WITH RIGHT SCIATICA.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Anamnesis:

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The patient came to the clinic 09-April-2008 complaining LBP for 12 years with right sciatica for 6 years

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The patient underwent unknown procedure in Ukraine 1 month ago without improvement.

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MRI of the lumbar spine performed 09-April-2008 showing central extrusion of L4-5 and dehydration of L3-4 and L5-S1.

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On examination SLRS was 60 degrees with scoliotic stance and weak dorsiflexion both feet 4/5.

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The patient was advised to keep in conservative treatment and in case of not improving, then consider surgery.

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The patient then came 05-August-2009 claiming that the LBP and sciatica increased and she is still scoliotic with weak dorsiflexion both feet 4/5 and planterflexion right foot 4/5. There is hypalgesia of the right L5 and S1 territories.

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The patient was sent for another MRI, which confirmed increase of the extrusion of L4-5.

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The ligamentum flavum of L4-5 was reflected to the left and foraminotomy of right L5 root was performed.  Removal of the extrusion of L4-5 was achieved lateral to the axilla. Meticulous cleaning of the disc space was performed. Using the Satellite PEEK nucleus replacement sphere the trial was reached with No 10 and the sphere No 11 was inserted with check under image-intensifier. The ligamentum flavum was reflect to its original place and routine closure of the wound.

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Smooth postoperative recovery with improvement of the power of both feet..


Comments

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The patient is young and to decrease the rate of postoperative recurrence PEEK nucleus replacement was preferable to decrease this rate.

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The height of the disc was shallow, for what the smallest size of the spheres was sufficient to increase the disc height.


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