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Multigen RF lesion generator .

15-FEBRUARY-2010  UMAR MUHAMED ALIAN  54 YEARS  EXTRUDED BLACK COLORED DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.

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 14-February-2010 complaining of LBP for 2 months with right sciatica and numbness right S1 territory and positive cough sign and unable to walk.

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On examination: the patient is in wheelchair and in agonizing pain. SLRS was 30 degrees in the right side. The right AJ is absent in the right side with drop right foot and weak planterflexion 3/5. There is hypalgesia right S1 territory.

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MRI lumbar spine done 13-February-2010 showing very huge extrusion L5-S1 with right far downward migration. The other disci are dehydrated with small bulges.

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Right L5-S1 hemiflavotomy with foraminotomy right S1 root down up to 10 mm to expose the subaxillary region. The extruded disc was removed in several pieces. It was black in color with black reactionary changes of the epidural tissues around the extrusion. Right sided cleaning of the disc space of L5-S1. The disc material and the annulus fibrosis were all also black with violet color attenuation.

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Using PEEK Satellite spinal system, was not necessary because of the disc space was very shallow. The osteophytic bony extrusion was drilled out to eliminate all the compressive elements near the root.

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The disc material and the extrusion was sent for biopsy.

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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 disappearance of right sciatica.


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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In retrospective analysis with the family, it became clear that half of the family showing manifestations of ochronosis, for what the disc material was black blue in color. This is the second case in my experience over 30 years having such a case.

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The shallow space of L5-S1 make it meaningless to use the PEEK Satellite sphere.


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