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Dr. Ali Al-Bayati

 
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16-JULY-2011  JAMAL ABDEL-RAHMAN ABDEL-RAB  53 YEARS  RECURRENT EXTRUDED DISC L5-S1 RIGHT SIDE.

Anamnesis

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The patient was operated elsewhere 2007 for PLD L5-S1 for left sciatica, but after surgery progressed right sciatica. The patient came to the clinic 05-July-2011 complaining of LBP with right sciatica which increased the last 2 months with numbness of the right L5 territory.

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MRI lumbar spine done 19-April-2007 before the surgery showing extruded disc L5-S1 right side. MRI lumbar spine repeated 15-July-2007 after surgery showing recurrent extrusion L5-S1. MRI lumbar spine done 04-July-2011 showing extruded disc L5-S1 with right downward migration.

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On examination: the patient was limping with scoliotic stance and weak dorsiflexion right foot 3/5 and planterflexion -4/5. There is dyseasthesia right L5,S1 territories. SLRS was 75 degrees with pain.

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Right S1 foraminotomy was done. The massive scar was removed from the right side down to the foraminotomy site. Check image-intensifier was used to locate the site of dissection.  The extruded downward migrating disc was adherent to the right S1 and S2 roots. Sharp dissection was necessary to free the roots of the extrusion. The extrusion was removed in several pieces and further cleaning of L5-S1 disc space was achieved from the right.

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Routine closure of the wound.  Smooth postoperative recovery with normalization of the power of the right  foot with disappearance of right sciatica.


 

 

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Comments

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The estimated postoperative recurrence rate is below 7% because the disc space of L5-S1 is shallow.

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The patient had recurrence even immediately after surgery, if it was not removed, but it could changed in consistency, shape and new recurrence took place the last 2 months.

 

 

 

 

 


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