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17-APRIL-2008  SHAREEF SULAYMAN AL-ATTAWNEH  52 YEARS  EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.

Anamnesis:

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The patient came to the clinic 15-April-2008 complaining of severe left sciatica for 4 days with LBP and numbness of left L5 territory.

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The patient was operated 1981 for PL L5-S1 with left sciatica. He was operated another time by me 01-October-2003 for recurrence at the same level.

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The patient then came 26-September-2007 with exacerbation of the left sciatica and hypalgesia of left S1 root. MRI of the lumbar spine performed 27-September-2007 showed small extrusion of L4-5 left side and no recurrence at L5-S1 level. The patient was advised to undergo conservative treatment.

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SLRS was 80 degrees in the right and 40 degrees in the left with pain. Limping when walking and exaggerated scoliotic stance. He had weak dorsiflexion left foot.

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MRI of the lumbar spine performed 16-April-2008 showed extruded disc L4-5 with left foraminal occlusion and downward migration.

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Left L4-5 hemiflavotomy with left L5 root foraminotomy was done. The extruded disc was removed lateral to the axilla and left sided cleaning of the L4-5 space was achieved.

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Routine closure of the wound with smooth postoperative recovery.

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Considerable improvement of the power of the left foot.

Comments

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The disc space height is still considerable, for what meticulous cleaning was performed to decrease the expected recurrence rate, which still remaining above the average.

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The presence of previous surgeries usually make protracted period of postoperative recovery.

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