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20-SEPTEMBER-2008  ADNAN MUHAMED EED AL-HALAQ  54 YEARS  HUGE EXTRUDED DISC L4-5 WITH MASSIVE LEFT DOWNWARD MIGRATION.

Anamnesis:

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The patient came to the clinic 17-September-2008 complaining of LBP with right sciatica for four years. The last three weeks got exacerbation of the LBP and left sciatica with numbness all toes both feet.

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MRI performed 11-September-2008 showed very huge extrusion of L4-5 disc with old right extrusion in the upper corner and left downward migration.

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The patient was treated elsewhere by traction for 5 days without benefit.

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On examination: the patient in agonizing pain with scoliotic stance and signs of urine dripping. The patient was limping dragging his left foot. SLRS was 80 degrees with pain with bilateral hypalgesia both L5 and S1 territories. He had almost drop left foot and weak dorsiflexion right foot 4/5. Planterflexion both feet 4/5.

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Bilateral flavotomy of L4-5 was done and foraminotomy of left L5 root was achieved.  Two very huge extruded disc material was removed from under the left axilla. Bilateral cleaning of the disc space was performed starting from the right side, then the left side. Meticulous cleaning was performed. The roots became lax.

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Routine closure of the wound and smooth postoperative recovery.

Comments

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The patient had very huge extrusion. Traction by no way will help, in the contrary, it will provoke damage to the neural structures.

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The estimated recurrence in this case is below the average <7%, because the disc height is less than average.

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