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25-FEBRUARY-2008  HASAN RAGHEB AL-QARANDAS  65 YEARS  EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.

Anamnesis:

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The patient came to the clinic 19-November-2007 complaining of LBP for two years with left sciatica. The last three months got right sciatica, then left sciatica.

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MRI performed 09-September-2007, showed dehydration of L3-4, L4-5 and L5-S1  with small extruded disc L4-5 with left downward migration.

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The patient was limping with scoliotic stance and had almost drop left foot. The patient was sent for another MRI of the lumbar spine, which was performed 22-November-2007 confirming the presence of the downward migration and foraminal occlusion left L4-5.

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Left L4-5 hemiflavotomy was performed and foraminotomy of left L5 root was achieved. The extruded disc under the root was identified and removed in piece-meal fashion, after what the root became lax. The disc material was old and sequestrated and part of it was adherent to the root, for what, so as to avoid tear of the root adhesions were left in place in the anterior portion of the root above the level of DRG. 

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Left sided cleaning of the disc space of L4-5 was performed. The disc space was not shallow.

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Routine closure of the wound and smooth postoperative recovery.

Comments

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The patient had considerable disc space height, which make the estimated recurrence around the average -  7%.

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The extruded disc was compressing the root, for what an agonizing pain was the prominent feature in her clinical picture. The morphologic changes of the root were an old one and there was a lot of adhesions with root. This could lower the rate of functional recovery. Despite this fact, the motor function recover immediately, but the pain pathways could remain for long time especially the pseudoradicular type.

 

 


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