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13-SEPTEMBER-2008  ALI MUHAMED ALI AL-HAJJY  38 YEARS  DE NOVO RECURRENT PLD L4-5 RIGHT SIDE.

Anamnesis:

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The patient came to the clinic 06-September-2008 complaining of LBP for 1 year with exacerbation of right sciatica the last 13 days.

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The patient was operated by me 29-January-2003 for extruded disc L5-S1 and L4-5 left side.

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MRI performed 04-September-2008 showing extruded disc L4-5 with right foraminal occlusion.

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On examination: the patient was limping with exaggerated scoliotic stance with weak dorsiflexion right foot 4/5 and hypalgesia right L5 territory.

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Considering that the extruded disc was soft a trail for conservative treatment was suggested to the patient, but the patient came 12-September-2008 complaining of agonizing right sciatica.

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Drilling of the upper right corner of the previous partial laminectomy of L4 was achieved and the ligamentum flavum was detached from the running right L5 root. The extruded disc was removed lateral to the axilla. Right sided cleaning of the practically empty disc space of L4-5. Some part of the extrusion was adherent to the root, removal of what caused a 1 mm tiny tear of the dural sleeve of the root. It was coagulated by bipolar to shrink the tear and small piece of muscle was applied over that area. Valsalva maneuver revealed no CSF leak.

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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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It was more wise to leave the L4-5 disc in the first surgery untouched, because, even the extrusion was in the contralateral side, but it was triggered by the previous violation.

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