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11-MARCH-2008  RAED KHADER HUSSEIN  38 YEARS  HUGE CENTRAL EXTRUSION L4-5 WITH DOWNWARD MIGRATION MORE THE RIGHT.

Anamnesis:

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The patient came to the clinic 09-March-2008 complaining of LBP for 5 years with left sciatica. He improved, then the last 2 months got exacerbation of bilateral sciatica more the left. He was walking with difficulty.

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On examination: he had exaggerated scoliotic stance with SLRS 45 degrees with pain both sides. Weak dorsiflexion both feet, more the left 3/5.

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MRI lumbar spine performed 05-March-2008  showing huge PLD L4-5 with central and downward migration, more to the right.

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Under image-intensifier, because he had lumbarized S1, the level was identified, and bilateral flavotomy L4-5 with bilateral foraminotomy both L5 roots was done. Cleaning of the disc space was performed from the right, then from the left. The major extruded disc then came in one piece from the left side.

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Routine closure of the wound with smooth postoperative recovery.

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Immediate recovery of the power of both feet.

Comments

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Bilateral meticulous cleaning of the disc space is not a preferable procedure, because, it could increase the stress at the facet joints with subsequent long postoperative period.

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In this case it was necessary to do this so as to decrease the rate of recurrence.

 

 


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