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15-MARCH-2004  AZIZA SULAYMAN SALEM ABDEL-RAHMAN  EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.

Anamnesis:

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The patient came to the clinic 02-July-2008 complaining of LBP for 6 years with right hip pain. Exacerbation of right sciatica the last 6 months.

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MRI of the lumbar spine performed 19-June-2008 showed extruded disc L5-S1 with small, but severe compression of the right S1 root.

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On examination: the patient is limping with scoliotic stance . SLRS was 80 degrees in the right with pain. There is weak dorsi and planterflexion right foot  4/5.

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The patient was advised to try conservative treatment, because the extrusion was not large, but he insisted for surgery, because the pain during the lest 6 months making his life intolerable.

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Right S1 foraminotomy with partial L5-S1 flavotomy was performed. The extruded sic was severely compressing the right S1 root. It was removed in two pieces. The disc space was cleaned meticulously from the right side.

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Routine closure of the wound and smooth postoperative recovery with normalization of the power of the right foot.

Comments

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The patient has relatively small extrusion, but with severe compression upon the right S1 root.  In these circumstances 2 out of 8 patients undergo surgery.

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The estimated recurrence in this case is around the average, because the disc space height still not shallow, but the defect in the annulus fibrosis is tiny small.

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