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14-FEBRUARY-2010  AYSHEH SULAYMAN ALIYAN  60 YEARS  SEVERE LUMBAR CANAL STENOSIS L4-5 WITH EXTRUDED DISC LEFT UPWARD AND RIGHT DOWNWARD.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Anamnesis

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The patient came to the clinic 06-February-2010 complaining of LBP and bilateral sciatica more the left for 2 years. The patient cannot walk more than 20 meters.

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On examination: the patient is limping with exaggerated scoliotic stance . SLRS was 90 degrees in both sides. The KJ is absent in left side with weak dorsiflexion 4/5 of the right foot and almost drop left foot. She had severe OA both knees without pain.

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MRI lumbar spine requested and done 09-February-2010 showing very severe lumbar canal stenosis L4-5 with lesser degree at L3-4 with extruded disc L4-5 with left upward and right downward extrusion..

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Decompressive laminectomy of L4 and partial of L3 and L5 with foraminotomy of both L5 roots. The extruded disc was removed from both sides and meticulous cleaning of L4-5  was achieved from both sides. Using irrigation with saline the friable fragments were removed from the contralateral points of entry.

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Using PEEK Satellite spinal system, was not necessary because of the patient age and presence of stenosis.

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Routine closure of the wound.

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Smooth postoperative recovery, with normalization of the power of the right foot and improvement of the power of the left foot..


Comments

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The surgeon thinks that he performed meticulous cleaning of the disc space, but it is not true. It is impossible to clean the disc space from even both sides, using the available standards.

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Using irrigation with saline under pressure increase the cleaning degree of loose disc fragments and push the annulus fibrosis, making possible to remove further intradiscal material, as in this case.

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The presence of stenosis make insertion of PEEK sphere impossible without violating the isthmus, for what the idea of nucleus replacement device was abandoned in this case.


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