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10-JUNE-2008  MUSA HUSSEIN ELEWAT  56 YEARS RECURRENT PLD L5-S1 WITH LEFT UPWARD MIGRATION AND ELEMENTS OF L4-5 STENOSIS.

Anamnesis:

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The patient came to the clinic 03-June-2008 with sciatica for three months more the left. He was operated 2003 for PLD L5-S1 for the same sciatica.

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On examination: the patient has weak dorsiflexion both feet 4/5 and planterflexion right foot 4/5.

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MRI lumbar spine performed 05-June-2008 showing very recurrence at L5-S1 more to the left with upward migration with elements of segmental stenosis at L4-5.

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Laminectomy L5 and partial of L4 was performed. The compressive elements of L4-5 were eliminated. Scarolysis of the left S1 root was performed. Considering that the disc space of L5-S1 was very narrow, image-intensifier was used to confirm the level of L5-S1. All the extruded disc with the upward migrating part were removed.

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Smooth postoperative recovery and normalization of the power of both feet.

Comments

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The recurrence rate in this case is around zero, because the disc space height is very minimal.

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Recurrent disc leave scar, for what dissection must be started from the healthy tissues.

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Good imagination of the extrusion must be kept in mind so as not to miss the extrusion, as in this case. It was necessary to perform isolated surgical route to remove the upward migrating piece.

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