|
The patient came to the clinic
22-May-2005 with a history of LBP for 10 years. He had left sciatica
the last week. MRI done 18-October-2004 showed moderate extrusion of
L3-4 with left downward migration and bulging L4-5 disc. He was
limping with scoliotic stance with left SLRS 20 degrees and
weak dorsiflexion all toes left foot with hypalgesia below the left
knee. The patient was advised to undergo surgery, but he
disappeared.
The patient then came 19-February-2006 with MRI
performed 23-May-2005 showing huge extrusion of the L3-4 disc. His
neurological status was worst with weak quadriceps of the left leg
and hypalgesia above the left knee and SLRS 10 degrees in the left
side. The patient was sent for another MRI, which confirmed the
still present huge fragment of the migrating disc material at the
same location and he was advised to undergo surgery.
The patient was operated. Left
L3-4 hemiflavotomy and foraminotomy of the left L4 root was
performed. The extruded disc was removed lateral to the root. It was
adherent to the dural sac, but complete removal of the extrusion was
achieved.
Inspection of the lateral wall of the annulus
fibrosis, revealed, that it is intact, for what the defect,
through which the extrusion took place was sought and found and
minimal cleaning of the disc space was performed.
Routine closure of the wound and the power of the
lower limb recovered upon his recovery from anaesthesia.
Comments:
1. In this case, in the contrary to the previous
case. it was possible to remove the extruded migrated disc and to
make minimal cleaning of the disc space without enlarging the
defect, through which the extrusion took place.
2. Inspection of the annulus fibrosis was that,
it will not cause sciatica to the patient and it will give barrier
for further slippage of the intradiscal fragments.
3. Not all the time the disc material degenerate
and shrink over even a long period of time, as in this case. In
other cases, when patients coming after long period of time with
disappearance of the fragment, the patient continue to suffer
from the irreversible damage to roots and in this case surgery will
be of no benefit. | 
