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21-MAY-2012  MAHBUBA HASAN AL-BALAAWI  55 YEARS  HUGE EXTRUDED DISC L4-5 MORE TO THE LEFT WITH SEVERE SEGMENTAL STENOSIS.

 

Anamnesis

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The patient  came to the clinic 13-May-2012 complaining of LBP for 15 years with left sciatica for 10 years. She notices deterioration the last 7 months with bilateral sciatica more to the left. MRI lumbar spine performed 03-May-2012 showing huge extruded disc L4-5 more to the left with severe segmental stenosis.

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On examination, the patient cannot walk more than 50 meters due to pain. She is limping with exaggerated scoliotic stance. SLRS was 80 degrees with pain in the right and 85 degrees in the left with pain. Weak dorsiflexion left foot 3/5 and dorsiflexion right foot and planterflexion both feet -4/5.

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Bilateral foraminotomy L5 roots. The dura was transparent due to severe compression. Removal of the extrusion lateral to the left L5 axilla with cleaning of the L4-5 disc space. The left L5 root still tightly elevated backward, for what subaxillary inspection was performed. An extradural fragments were removed, followed with intradural pieces were pulled out from the dural defect under the axilla. The intradural pieces were not violating the subarachnoid, for what CSF leak was not noted. Putting the patient in head up position with Valsalva maneuver did not trigger CSF leak. A piece of muscle was put at the dural defect for 2 reasons, to stop the epidural bleeding and prevent postoperative CSF leak.

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Routine closure of the wound. Smooth postoperative recovery and the power of both feet normalized.

 

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Comments

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The patient has lumbar canal stenosis of L4-5 with huge extruded disc more to the left. Bilateral cleaning is a must.

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The estimated postoperative recurrence is around 7%, because the disc space height is still not shallow.

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It is rare to see an intradural sequester of the extruded disc. It happens in 0,5% cases. Missing these fragments will make the patient suffer and it happened in some patients, that they underwent 10 redo surgeries for missing these fragments.

 


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