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31-MAY-2010  TAYMA MUHAMED ABUL-FILAT  40 YEARS  EXTRUDED DISC L5-S1 WITH RIGHT S1 ROOT COMPRESSION.

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 23-December-2009 complaining of LBP for 4 years with left sciatica. MRI performed 06-June-2005 showed extruded disc L5-S1 with bulge L4-5. MRI lumbar spine repeated 24-April-2007 showed extruded disc L4-5 with left downward migration.

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On examination at that time, SLRS was 75 degrees both sides with pain without weakness or sensory deficit. She was sent for another MRI which was performed 24-December-2009 showing shrinkage of L4-5 disc extrusion, but same extrusion of L5-S1. The patient was advised to keep in conservative measures.

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The patient then came 23-February-2010 complaining of exacerbation of LBP with bilateral sciatica more the right with exaggerated scoliotic stance. She had weak dorsi and planterflexion right foot 4/5 with SLRS 70 degrees in the right with pain.

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MRI of the lumbar spine performed 27-February-2010 showing extruded disc L5-S1 with compression of the right S1 root.

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Right L5-S1 hemiflavotomy was performed and foraminotomy right S1 root was achieved. The extruded disc was identified and removed after what the root was free of compression. Inspection of the shallow disc space of L5-S1 revealed that it was empty, for what it was not violated.

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Routine closure of the wound and smooth postoperative recovery with full recovery of the power of the right foot.


Comments

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The patient had evolution of the clinical picture and most of the time it was changing.

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The extruded disc of L5-S1 was persisting all the time and it became more large, in the contrary the extrusion of L4-5 shrunk with time.

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The patient is in agonizing right sciatica, for what surgical removal of the extrusion was the only remaining solution.

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The expected recurrence rate in this case is minimal since the disc space is shallow and empty.


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