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25-AUGUST-2004 ABDEL-RAHMAN ALI AL-BASHARI 55
YEARS EXTRUDED DISC L4-5 WITH SEGMENTAL STENOSIS.
The patient a Yemeni citizen, came
to the clinic 27-July2003 complaining of LBP for
4 years with right sciatica. MRI at that time
showed lumbar canal stenosis with extruded disc
more to the right. He was treated
conservatively. The last 70 days got right sciatica with
inability to walk more then 100 meters. MRI lumbar spine performed
27-July-2004 showing huge the same data as
On examination: The patient is limping with
exaggerated scoliotic stance. SLRS was 50
degrees in the right and 80 degrees in the
left with pain. There is
weak dorsiflexion both feet 3/5 with hypalgesia
both L5 and S1 territories.
both L5 roots with
removal of the huge extrusion lateral to the axilla
from the right side. After
that, the root became lax and right sided
intradiscal cleaning L4-5 disc space was done.
The patient was put in Reverse Trendelenburg
position with Valsalva maneuver and
hyperventilation. No CSF leak. A fat in pedicle was
transferred from the subcutaneous layer and
covered the exposed parts of the dura and roots
to minimize postoperative scarring. Routine
closure of the wound. Smooth postoperative
recovery. The power of the feet became
normal. He was
sent to the ward.
The patient came to the clinic 05-Septmber-2004
with clean wound and SLRS 80 degrees both sides
without pain and neurologically free.
The estimated postoperative recurrence is still
ranking around 7%, because the disc space is
still relatively not shallow.