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13-NOVEMBER-2010  IYAD MAHMOUD BARAKAT  38 YEARS  RECURRENT EXTRUDED DISC L4-5 WITH RIGHT DOWNWARD MIGRATION.

Anamnesis

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The patient came to the clinic 04-November-2010 complaining of LBP and right sciatica since he was operated elsewhere 2005 for left sciatica. The left sciatica disappeared after surgery, but right sciatica and drop right foot with micturiton problems took place after surgery.

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MRI lumbar spine performed 29-September-2010 showing recurrent PLD L4-5 with right downward migration.

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On examination: The patient  is limping with exaggerated scoliotic stance with weak dorsi and planterflexion right foot 3/5 and hypalgesia right L5 and S1 roots territories.

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MRI lumbar spine performed 07-November-2010 showing the same extrusion with root cut in the MR myelography.

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Right L4-5 hemiflavotomy with foraminotomy right L5 root was performed. The dura was severely compressed by the bony extruded downward migrating disc. Cleaning of the disc space lateral to the axilla and the bony extrusion was drilled out with high=speed drill to eliminate all the compressive components around the root.

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Routine closure of the wound. Smooth postoperative recovery and improvement of the power of right foot.


Comments

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The patient has old extrusion with severe compression upon the right L5 root, which is not changing over time. Surgery is the only solution to such situation.

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The estimated recurrence rate is still around 7% because the disc space is still not shallow.

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