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27-DECEMBER-2008  FAYSAL SHAMSI MUSA  38 YEARS  HUGE OLD PLD L5-S1 CENTRAL MORE TO THE LEFT WITH LUMBARIZATION OF THE SACRUM.

Anamnesis:

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The patient came to the clinic 14-August-2007 complaining of LBP and left sciatica for three months

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On examination: the patient  has exaggerated scoliotic stance. SLRS was 20 degrees right side and 5 degrees in the left with agonizing pain and. He had weak dorsi and planterflexion left foot 3/5 with hypalgesia left L5 root territory.

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MRI of the lumbar spine with MRMyelography was performed the next day and huge extrusion of L5-S1 with lumbarization of the sacrum was noted. The patient was advised to undergo surgery, but he disappeared.

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The patient then came 13-December-2008 with agonizing bilateral sciatica for the last 20 days. He had weak both feet with dorsi and planterflexion 3/5. He could not stand upright and walked bended with the help of two persons.

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Considering that the patient pain increased in the right side after the performed MRI another MRI was requested and done 13-December-2008 which confirmed the persistence of the huge disc L5-S1.

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Bilateral L5-S1 flavotomy and bilateral S1 foraminotomy was performed. There was no epidural fat in the area due to severe compression. The huge extruded disc was attacked from the left side lateral to the axilla. The extruded disc was removed in several pieces and meticulous cleaning of the disc space was performed from the left side. Inspection of the right side showed no extrusion and the annulus fibrosis was lax. Routine closure of the wound with water-tight multilayer stitching.

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Smooth postoperative recovery and the power of both feet normalized.


Comments

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Some patients with huge extrusion escape surgery and around 20% of them showing shrinkage of the extrusion, bypassing surgery, but with high price. The damage to the roots becoming permanent and surgery of no help.

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The expected recurrence rate in this case is still around the average, because the disc space height still not shallow.

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