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26-OCTOBER-2010  FAKHRY FUAD AL-DAJANI  30 YEARS  EXTRUDED DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.

Anamnesis

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The patient came to the clinic 21-October-2010 with history of LBP and right sciatica for 8 months.

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MRI performed 21-October-2010 showing bulge L3=4, L4-5 and extruded disc L5-S1 with right downward migration, compressing the right S1 root.

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On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 15 degrees with pain in the right. There is weak dorsiflexion -4/5 of the right foot. The patient had stiff back and unable to bend the spine.

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Right partial flavotomy L5-S1 was performed. Right S1 root foraminotomy. The extruded downward migrating disc was removed lateral to the axilla. Right sided cleaning L5-S1 disc space. The compressed tissues were lacking the epidural fat. After decompression the root became lax.

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Routine closure of the wound and smooth postoperative recovery disappearance of right sciatica and normalization of the power of the right foot.


Comments

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The patient has disc extrusion compressing severely the right S1 root, for what an agonizing pain having place.

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The disc extrusion was dark-gray, for what the chance for shrinkage over the time is ranking less than 10%. ( The white-gray disc extrusion have to shrink over the time more than 80% chance during 6-10 weeks).

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

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