patient was operated twice for PLD L5-S1
16 years ago elsewhere then was operated by me
for PLD L4-5. The patient then came to the clinic
complaining of weak right leg during walking for
one month, then agonizing right sciatica for the
last 12 days.
spine done 20-July-2011 showing huge extruded
disc L3-4 with right downward migration. There
is no recurrence of L4-5 with assimilation of
examination: the patient was limping walking
with widened gait with
scoliotic stance and
weak dorsiflexion left foot 3/5 which was
an old one and recently weak dorsiflexion right
foot 4/5. SLRS was 15 degrees in the
Using C-arm the L3-4 level
was identified and right L4 root foraminotomy
was done with extended subaxillary exposure.
Partial flavotomy of L3-4 was achieved. The huge
far downward migrating disc was removed from
under the axilla. It was removed in several
pieces. The disc space of L3-4 was violated and
meticulous cleaning was done from the right.
Further inspection of the axilla lateral,
revealed other fragments, which were removed.
The root became free. There was no epidural fat
at the severely compressed area.
closure of the wound. Smooth postoperative
recovery with normalization of the power of the
right foot with disappearance of right