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24-APRIL-2010  SAMIRA AHMAD THAHER  63 YEARS  EXTRUDED DISC L4-5 WITH RIGHT FORAMINAL OCCLUSION.

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 18-April-2010 complaining of LBP with right sciatica for 6 months with exacerbation last 2 weeks.

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MRI lumbar spine performed 25-January-2010 showed extruded disc L4-5 with right foraminal occlusion.

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On examination: the patient is limping with exaggerated scoliotic stance. There is weak dorsi and planterflexion right foot.

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Decompressive laminectomy L4 and partial of L5 was performed after checking for instability elements, which were negative. Right L5 root foraminotomy. There was no epidural fat, due to severe compression all over the field. Inspection of the disc  of L4-5 right side revealed considerable compression to the root anteriorly, which was removed by piece-meal resection. The root became lax and free. Inspection of the disc space which was severely narrow, for what it was not violated.

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Routine closure of the wound.

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Smooth postoperative recovery, with full recovery of the power of the right foot.


Comments

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The patient  has severe compression of the right L5 root with agonizing pain and weak right foot. The retrolisthesis at this part of the extrusion could be a secondary phenomenon due to the extrusion or an old one. There was no signs of instability or overmobility of any bony structures during the operation.

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The disc space was very narrow (<1mm) , for what it was decided not to violate the disc space.

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Foraminotomy alone can decompress the root, but removal of the extrusion is better to make sure that there is no postoperative source of pain.


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