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21-JULY-2010  IMAD ZAKARIYA AL-NATSHEH  32 YEARS  EXTRUDED DISC L4-5 WITH SEVERE SEGMENTAL STENOSIS.

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 24-May-2010 complaining of LBP with right sciatica  for 4 years , which was previously in the left.

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On examination: the patient was limping with exaggerated scoliotic stance. SLRS was 70 degrees in the right and 45 degrees in the left. There was hypalgesia above the knee in the right and below the knee in the left with weak dorsiflexion both feet 4/5 and planterflexion right foot 4/5.

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MRI done 25-May-2010 showing severe lumbar canal stenosis L3-4 and L4-5 with extruded disc L4-5 more in the left.

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Decompressive laminectomy of L4 and partial of  L5 with  foraminotomy of L5 roots both sides. There is no epidural fat and no overmobility of the segments. Inspection of the annulus fibrosis revealed the extrusion in the left side, which was removed and the disc space of L4-5 was removed from the left side. The right side was inspected and it was decided not to violate the annulus fibrosis from the right side.

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Routine closure of the wound and smooth postoperative recovery.

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The power of both feet dramatically improved.


Comments

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Lumbar canal stenosis is a progressive disease and early surgical intervention in case of progression avoid the patient unnecessary possible complication..

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Total decompression must be performed including the canal and the roots. and removal of the extrusion must be performed, because in case of leaving it . it will extruded more because there is plenty of space to extrude further after the surgery.

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The estimated recurrence rate in this case is ranking around 7%, because the disc space height still not shallow.


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