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18-NOVEMBER-2009  MUUMEN GHULAM AL-SAMERAEE  20 YEARS  EXTRUDED CENTRAL DISC MORE TO THE LEFT L4-5.

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 11-November-2009 from Iraq complaining of LBP with left sciatica for 7 months down to L5 territory.

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MRI lumbar spine performed 09-November-2009 showing extruded disc L4-5 central more to the left with downward migration.

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The patient was limping with exaggerated scoliotic stance. SLRS 35 degrees in the right and 30 degrees in the left. He had weak dorsiflexion both feet 4/5 right and 3/4 left side with hypalgesia left L5 and S1 territories.

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Left L4-5 hemiflavotomy with exposure of the compressed left L5 root.  There was no epidural fat due to severe compression. Using image-intensifier during all steps of surgery the level of L4-5 was confirmed and the extruded disc was removed lateral to the axilla of left L5 root. Meticulous cleaning of the disc space of L4-5 was achieved from the left. The root from the begging of the surgery had small tear in the most lateral aspect without CSF leak which was left until the end of the surgery.

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PEEK Satellite nucleus replacement sphere No 12 was inserted and check in AP and lateral views was done confirming acceptable position of the device.

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The dural defect which was 1 mm length was stitched using one stitch of 6 zero nylon. Check for CSF leak while putting the head of the patient high and using Valsalva maneuver was negative for CSF leak.

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Routine closure of the wound and smooth postoperative recovery and improvement of the power of both feet.


Comments

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Recurrence of disc prolapse is around 15% in this case because the disc space is still high and the defect of the annulus fibrosis is wide.

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To minimize this to 2%, PEEK Satellite nucleus replacement sphere was applied.


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