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The patient came to the clinic
22-February-2006 with agonizing sciatica right side and drop right
foot with weak planterflexion right foot and hypalgesia right S1
territory. MRI of the lumbar spine showed lumbarization of the
sacrum with extruded disc L5-S1 right side.
The patient was operated the next day. Right
L5-S1 hemiflavotomy and foraminotomy of the right S1 root was
performed. The extruded disc was removed lateral to the root. It was
adherent to the veins, for what it was necessary to coagulate the
veins, which usually I preserve them.
Inspection of the lateral wall of the annulus
fibrosis, revealed, that it is movable, and it could cause pain to
the patient after surgery, for what, all the movable part of the
annulus fibrosis was removed. Considering that the disc space
opening was wide, meticulous cleaning of the disc material from the
space was performed, to lower the incidence of recurrence.
Dramatic postoperative recovery and the patient
discharged the next day.
Comments:
1. The recently, accepted policy to remove the
extrusion and to remove lesser disc material without widening the
hole, through which minimal cleaning of the disc space, not all the
time is possible. Here a demonstration that the movable part of the
annulus fibrosis must be removed, creating by that a large defect in
the wall of the disc space.
2. In that case a meticulous cleaning of the disc
space is mandatory, to lower the incidence of the recurrence. | 
