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31-JULY-2010  BILAL NAFETH SALEH NASER  32 YEARS  HUGE EXTRUDED DISC L5-S1 WITH RIGHT 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-July-2010 complaining of LBP for 4 years with right sciatica for 4 months down to the heel without improvement, despite all measures including intrathecal enzymotherapy, which was performed 01-June-2010.

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MRI lumbar spine performed 29-April-2010 showing huge extruded disc L5-S1 with right downward migration.

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On examination: the patient is limping with very exaggerated scoliotic stance with SLRS 20 degrees with pain in the right and weak dorsi -4/5 and planterflexion 4/5 of the right foot.

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MRI of the lumbar spine was repeated 29-July-2010 showing the same previous data.

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Partial flavotomy L5-S1 right side was done. Foraminotomy of S1 root was achieved. The epidural fat was rubbery in consistency due to previous epidural enzymo-therapy. The extruded disc was removed in several pieces after what the the root regained relaxed position. Meticulous cleaning of the L5-S1 disc space from the right.

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Smooth postoperative recovery and normalization of the power of right foot.


Comments

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This case is the 10th case after enzymotherapy. The cases were put under careful study and at various periods of time.  It seems that enzymotherapy is useless and it harm the epidural tissue, which can minimize the recovery in the postoperative period. This modality of treatment must be stopped, because it is not effective and useless.

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It happens that huge extrusions shrink by time, but this depends upon the water content of the extruded fragment, which could be caught by the MRI data. If the extrusion is white, it means that it is fresh and watery. These cases shrink in more than 80% of cases. If the fragment is medium gray, then the percent of shrinking will be around 40%. If the extrusion is gray-dark, then the possibility of shrinking is minimal.

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The expected recurrence rate in this case is more than 7% because the defect in the annulus fibrosis is wide and the disc space is still not shallow.


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