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31-AUGUST-2009  NASER IBRAHEEM SALEM  33 YEARS  EXTRUDED DISC L5-S1 WITH RIGHT UP AND DOWNWARD MIGRATION.

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 29-August-2009 complaining of LBP for 2 years  with right sciatica for 2 months.

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MRI lumbar spine performed 04-June-2009 showing extruded disc L5-S1 right side.

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On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 30 degrees in the right with pain with weak dorsi and planterflexion right foot 4/5.

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The patient was sent for new MRI, which was done 30-August-2009 showing increase of the extrusion.

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Right S1 foraminotomy with cleaning of the extruded disc material lateral to the axilla. The disc space was meticulously cleaned from the right.

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Medtronic PEEK satellite nucleus replacement sphere No 13 was inserted in the disc space and check image-intensifier was used to confirm position.

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Routine closure of the wound and smooth postoperative recovery and the patient sent to the ward.


Comments

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The patient still having disc space with considerable height and he is young. The expected recurrence rate in this case could be ranking higher than 10%.

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PEEK satellite sphere was used to minimize the postoperative recurrence rate and keep segmental movement at this level.

Postoperative course
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The patient still having scoliotic stance and no sciatica.  MRI performed 18-November-2009 showing no recurrence, but the sphere is shifted to the right.

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PEEK satellite sphere must be installed at the center , as it was performed in this case, but it could migrate off the center if the patient progressing exaggerated scoliotic stance. Follow up studies will clarify what is the cause and what is the result.

Figure-1: The patient scoliotic stance and radiological findings 2 months after surgery.


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