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27-JULY-2010  AMANI MUHAMED SALEEM NAGHOJ  32 YEARS HUGE EXTRUDED DISC L4-5 CENTRAL MORE TO THE LEFT.

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 13-April-2002 complaining of LBP with left sciatica for 7 months. MRI performed 16-April-2002 showed huge extruded disc L4-5 and surgery was advised and disappeared.

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The patient then came 19-July-2010 complaining of exacerbation of the LBP with agonizing left sciatica.

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On examination: the patient had exaggerated scoliotic stance, limping, weak dorsiflexion and planterflexion left foot 4/5. The patient also had enlarged thyroid.

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MRI lumbar spine performed 20-July-2010 showing the same extrusion central more to the left. Thyroid functions showed high TSH with multinodular goiter.

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Partial flavotomy of the L4-5 left side with foraminotomy left L5 root. The extruded disc was removed in several pieces and meticulous cleaning of the disc space was achieved from the left side.

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Smooth postoperative recovery and improvement of the power of left foot.


Comments

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This case demonstrate that the patient can tolerate huge disc for long time, but stress due to continuous pain caused thyroid malfunction.

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Some times it happens that the disc extrusion resolve over the time, but this phenomenon happens with in 3-4 months and the patient recover completely.

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In this case, this could was the case and de novo extrusion took place at the same level. Her distressing pain enforced her to the surgical option.


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