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10-JULY-2008  JAMILA MUHAMED ALIA  64 YEARS  EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.

Anamnesis:

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The patient came to the clinic 07-July-2008 complaining of LBP with left sciatica for four months with exacerbation the last 2 days. The patient is a known hypertensive patient.

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On examination: the patient in agonizing pain with scoliotic stance  with SLRS 80 degrees in the right and 50 degrees in the left with pain. She had weak dorsiflexion left foot 4/5 and planterflexion left foot 4/5 with hypalgesia left S1 root territory. She has severe OA both knees.

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The patient was sent for MRI lumbar spine  which was performed 08-July-2008 showing PLD L4-5  with left downward migration compressing the left L5 root. The patient has severe osteoporosis, for what protelose was started.

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Using image-intensifier, because the patient has elements of sacralization of L5, left L4-5 hemiflavotomy was performed. Left L5 root foraminotomy was achieved. The left L5 root was severely compressed and adherent to the extruded disc. It was necessary to clean the disc space of L4-5 from the left side so as to obtain some redundancy to dissect the running root off the extruded disc, which was removed in three separate pieces. The root regained normal appearance and the foramen was checked for remnants.

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Routine closure of the wound and smooth postoperative recovery with normalization of the power of left foot.

Comments

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The patient was in agonizing pain due to severe root compression. She could not sleep for the last week from pain.

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The expected recurrence in this case is around the average, because the disc height still not shallow.

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