The patient came 20-August-2006 complaining of left sciatica the
last month with numbness and pain in the left S1 root territory. MRI
of the lumbar spine performed 29-July-2006 showing huge extrusion
L5-S1 with left downward migration.
On examination; the patient in
agonizing pain with scoliotic stance and limping. SLRS was 45
degrees in the left with pain, hypalgesia left S1 root and weak
dorsi and planterflexion left foot.
Left S1 foraminotomy was performed with partial left
hemiflavotomy. The extruded disc removed in 2 separate pieces
from under the axilla, after what the root regained relaxed position. Inspection of the
annulus fibrosis lateral to the axilla showed pin-point defect and relatively glistening
surface, for what it was decided not to violate the disc space.
1. In this case only the extruded piece was removed and the disc
space was not violated because the defect in the annulus fibrosis
practically was not visible. Time will tell if such strategy will
diminish the rate of recurrence.