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08-JUNE-2011  RASMI AHMAD ANABTAWY  70 YEARS  EXTRUDED DISC L2-3 WITH LEFT DOWNWARD MIGRATION.

Anamnesis

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The patient came to the clinic 01-June-2011 complaining of LBP for 3 months after performing surgery for left inguinal hernia repair 01-March-2011. One week later progressed left sciatica. The patient is known diabetic under treatment for 7 years.

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MRI of the lumbar spine performed 19-May-2011 of bad quality showed extruded disc L2-3 with left downward migration.

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On examination: the patient is limping with exaggerated scoliotic stance with SLRS was 90 degrees in both sides. The knee Jerk is absent in the left side. There is weak dorsiflexion left foot 4/5 and weak quadriceps muscle left leg 4/5.

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Using image-intensifier, the L2-3 was indentified. Left L3 foraminotomy with partial L2-3 flavotomy was performed from the left. The extruded downward migrating disc was removed in one piece lateral to the root. Left sided cleaning L2-3 disc space was achieved. The area was lacking the epidural fat due to severe compression. The root and dural structures regained relaxed position at the end of surgery.

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Routine closure of the wound.  The sciatica disappeared and the power of the left leg improved.


 

 

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

Comments

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The estimated recurrence rate is around 7% because the disc space was not shallow.

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It was appealing that removal of the extrusion was sufficient in this case, but due to bad experience with such cases with high level of postoperative recurrence, it was decided to clean the intradiscal material to lower this incidence.

 

 


 

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