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The patient came 05-August-2006 complaining of left sciatica the
last month progressed to bilateral sciatica the last week more to
the right and urgency with frequency. MRI of the lumbar spine done
03-August-2006 showed a huge PLD L3-4. The patient was operated for
recurrent disc L4-5 22-May-2005.
On examination: the patient was limping with SLRS 10 degrees both
sides with weak planter and dorsiflexion both feet. Hypalgesia both
lower limbs below the knee.
Bilateral flavotomy with bilateral foraminotomy both L4 roots was
achieved. The extruded disc was attacked from the right and it was
removed in one piece. Bilateral cleaning of the disc space and check
of the roots for presence of any extrusions was done. Meticulous
cleaning of the disc space was performed, since the defect in the
annulus fibrosis was wide.
Comments:
1. In case of presence of central huge disc as in this case, to
minimize the traction injury, it is preferable to perform
intradiscal cleaning, then tract the extrusion to the intradiscal
space and from there, remove it. By this means, the level of
surgical trauma must be minimized.
2. Bilateral cleaning is a must in this case to avoid missing
pieces. |
