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The patient came to the clinic 25-June-2006 complaining of LBP for 3
years after falling down with right sciatica. Exacerbation of LBP
with bilateral sciatica the last 15 days more the right with
positive cough sign. MRI lumbar spine done 08-June-2006 showing
huge extrusion L3-4 with small bulge L4-5. The extrusion is more in
the right side in the upper corner with left downward migration.
On examination, the patient has dripping urine for 14 days,
limping and unable to lay supine for examination, with scoliotic
stance. SLRS was unable to perform due to pain with absent KJ in the
right. The patient had cauda equina syndrome with weak dorsi and
planterflexion right foot.
Using image intensifier, the L3-4 was identified and with
methylin-blue the level was marked. Bilateral L3-4
LBP for 3 years after falling down with right sciatica. Exacerbation
of LBP with bilateral sciatica the last 15 days more the right with
positive cough sign.MRI lumbar spine done 08-June-2006 showing
huge extrusion L3-4 with small bulge L4-5. The extrusion is more in
the right side in the upper corner with left downward migration.
On examination, the patient has dripping urine for 14 days,
limping and unable to lay supine for examination, with scoliotic
stance. SLRS was unable to perform due to pain with absent KJ in the
right. The patient had cauda equina syndrome with weak dorsi and
planterflexion right foot.
Using image intensifier, the L3-4 was identified and with
methylin-blue the level was marked. Bilateral L3-4 was performed and
bilateral foraminotomy. First the right upper corner of the exposure
was prepared and a huge extrusion was removed lateral to the axilla.
The right root became relaxed, but the other side still tight.
Another huge extrusion was removed from the left side and bilateral
cleaning of the disc space was performed after what both roots
became lax and redundant
was performed and bilateral foraminotomy. First the right
upper corner of the exposure was prepared and a huge extrusion was
removed lateral to the axilla. The right root became relaxed, but
the other side still tight. Another huge extrusion was removed from
the left side and bilateral cleaning of the disc space was performed
after what both roots became lax and redundant. Routine closure of
the wound.
Smooth postoperative recovery.
Comments: 1. Do not ever be
satisfied with the removal of huge piece of extrusion from one side.
Inspect the other side, as in this case, an even bigger piece can be
hidden in the other side. 2. Good inspection of both roots is
mandatory when the patient has cauda equina syndrome and bilateral
foraminotomy is a must. |
