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09-AUGUST-2010  JAMAL HASAN ISSA  53 YEARS  HUGE EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION AND SECONDARY CANAL STENOSIS.

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 01-August-2010 complaining of LBP for 20 years with left sciatica. Exacerbation of left sciatica the last 3 months down to the left L5 territory.

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MRI done 20-July-2010 showing severe lumbar canal stenosis L4-5 with extruded disc L4-5 with left downward migration.

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On examination: the patient walking bended with exaggerated scoliotic stance. SLRS was 70 degrees left side with pain There was weak dorsiflexion left foot -3/5 right 4/5, and planterflexion left foot -4/5. There was mild O.A. both knees without pain.

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Left L4-5 hemiflavotomy with foraminotomy of left L5 root. There was no epidural fat in the compressed parts. The extruded disc was removed in several pieces. after what the root became lax. Meticulous cleaning of L4-5 disc space from the left side lateral to the axilla. Inspection under the axilla revealed no remnants of the extrusion.

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Routine closure of the wound and smooth postoperative recovery.

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The power of both feet dramatically improved.


Comments

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Lumbar canal stenosis is the result of the huge extrusion and surgical intervention was aimed to resolve the huge extrusion.

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The expected postoperative recurrence rate in this case is around 7% because the disc space still not shallow and the defect in the annulus fibrosis is wide.


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