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29-MAY-2011  PROF. ALI UTHMAN SHABOU  70 YEARS  EXTRUDED DISC L4-5 WITH LEFT FORAMINAL OCCLUSION.

Anamnesis

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The patient a Sudanese Professor in Arabic language came to the clinic 23-May-2011 complaining of LBP with left sciatica for 3 months after turning his trunk.  The patient also complaining of tremor both hands more the left for 4 months. He has memory disturbance for 5 years. The last 2 months has difficulty in producing loud voices. The patient felt down 20 months ago and got stable fracture of L1, treated conservatively. The patient is a known diabetic under treatment for 16 years. He has arterial hypertension for 7 years. He had head injury 1984 with old cut wound in the forehead left side.

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MRI of the brain and lumbar spine performed several times showing widened ventricular system with scattered tiny lacunar infarctions periventricular. He had wedge fracture of L1 which increased over the time, but stabilized the last year. MRI lumbar spine performed 06-April-2011 showed the wedge fracture of L1, which was seen in all previous MRI studies and extruded disc L4-5 with left foraminal occlusion which was not noted in the previous investigations.

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The patient was sent for new investigations which confirmed the presence of the extrusion L4-5 with complete occlusion left L4-5 foramen. The old fracture of L1 is the same and simple X-rays confirmed the presence of calcifications of L1 and D12.  There is mild stenosis of left ICA with tortuous arteries. with same scattered lacunar infarctions as seen before.

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On examination: the patient is limping with exaggerated scoliotic stance and swaying to the left when walking. SLRS was 70 degrees with pain in both sides. There is weak dorsiflexion left foot 3/5. There is severe OA both knees without pain.

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Left L1 foraminotomy with exposure of the subaxillary area 10 mm below the axilla. The extruded disc was removed lateral to the axilla and left sided cleaning of L4-5 disc space was achieved.

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Routine closure of the wound.  The sciatica disappeared and the power of the left foot regained full power.


 

 

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Comments

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The patient came with this extrusion still the same over the period of 4 months, for what surgery was advised.

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The estimated recurrence rate is around 7% because the disc space was not shallow.

 

 

 


 

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Notice: Head injuries and very urgent surgeries are also escaped from the plan .

 

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