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11-SEPTEMBER-2008  NAZEK BADEE ISSA  45 YEARS  HUGE EXTRUDED DISC L4-5 WITH LEFT FORAMINAL OCCLUSION.

Anamnesis:

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The patient came 10-September-2008 with agonizing left sciatica for 20 days and inability to walk or stand the last 2 weeks. She had LBP with minimal left sciatica for three years.

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MRI performed 30-August-2008 showing extruded disc L4-5 with left foraminal occlusion.

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On examination: the patient was dancing due to pain and she could not be evaluated for scoliotic stance and SLRS.  She had weak dorsi 3/4 and planterflexion 4/5 of the left foot with OA left knee and she had psoriasis and hypertension for 4 years.

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Left L5 root foraminotomy was performed and partial flavotomy was achieved. There was no epidural fat at the disc level and a huge calcified ganglion arising from the left L4-5 facet was removed and drilled off.

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The extruded disc was also compressing the nerve from anterior, for what left sided cleaning of the disc space was performed, after what the root became lax.

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Routine closure of the wound and smooth postoperative recovery.

Comments

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The patient had very relatively shallow disc space of L4-5 , for what the estimated recurrence rate is below 7%.

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The major role in compression in this case was the extruded ganglion from the left facet joint, which mimicked a huge extrusion with foraminal occlusion.

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MRI was not informative to catch this situation before surgery. More precise resolution and new modifications of MRI or other technologies must give the answer for this situation before surgery. We hope in the near future, this problem to be resolved.

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