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Multigen RF lesion generator .

 

21-SEPTEMBER-2008  MUHAMED IBRAHEEM HASAN  67 YEARS  EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION AND COMPLETE FORAMINAL OBLITERATION.

Anamnesis:

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The patient started to complain of LBP with left sciatica for eight months. The last three weeks got exacerbation of the LBP and left sciatica with numbness all toes left foot.

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MRI performed 11-September-2008 showed extruded disc of L4-5 with left downward migration and complete occlusion of the left foramen.

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On examination: the patient in agonizing pain. The patient had hypalgesia of left L5 territory. He had almost drop left foot and weak planterflexion left foot 4/5.

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Left hemiflavotomy of L4-5 was done and foraminotomy of left L5 root was achieved.  The extruded with down migrating piece was removed in several fragments. Considering that the disc space still high and the annulus fibrosis is not hard and there is defect under the annulus, it was decided to clean the L4-5 disc space meticulously from the left side.

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Coagulation around the defect of the annulus fibrosis to shrink the diameters of the defect.

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Routine closure of the wound and smooth postoperative recovery.

Comments

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The patient had complete obliteration of the left L4-5 foramen with severe compression of the left L5 root. This must be resolved by surgery.

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The estimated recurrence in this case is around the average -7%, because the disc height is not shallow. Coagulation of the defect of the annulus fibrosis  decrease the dimensions of the defect, which theoretically could lead to lower the estimated postoperative recurrence.

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