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16-JULY-2009  NIDA YASEEN HASAN  28 YEARS  VERY HUGE EXTRUDED DISC L5-S1 WITH RIGHT INFERIOR MIGRATION POSTERIOR TO THE DURAL SAC.

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 12-July-2009 complaining of LBP and right sciatica for 1 week with numbness of the right foot.

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On examination: the patient is limping with scoliotic stance, SLRS was 30 degrees in the right with pain and weak dorsi and planterflexion right foot 3/5 with hypalgesia of right L5 and S1 territories.

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The patient was sent to perform MRI lumbar spine, which confirmed the presence of very huge extruded disc L5-S1more in the right with downward migration posterior to the dural sac.

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Bilateral flavotomy of L5-S1. Both sides of the dural sleeve was exposed. The disc material was covering the dura and it was adherent to it. It was necessary to sharp dissect the disc material of the thin dura and it was removed in several pieces from the right side.  Right sided cleaning of the disc space.

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Considering the age of the patient and still not shallow disc space height, the Satellite PEEK nucleus replacement No 11 was inserted from the right side and checked with image-intensifier.

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Routine closure of the wound.

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Smooth postoperative recovery with improvement of the power of the right foot.


Comments

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This is the first time over 30 years period I see such a big extrusion which cover the dura and it was necessary to dissect it shapely to remove it and proceed with further removal of the extrusion.

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Considering the young age and still not shallow disc space of L5-S1 it was preferable to insert the satellite nucleus replacement  to decrease the rate of recurrence and preserve some functionality to this segment of the spine.


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