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29-AUGUST-2004 MANAL ABDALLAH SUWAN 33 YEARS
RECURRENT LEFT EXTRUDED DISC L4-5 WITH DROP LEFT FOOT.
The patient came to the clinic 16-November-2000
telling that she was operated 10-May-1997 for
PLD L4-5 elsewhere and improved. The last month
got exacerbation of LBP with left sciatica as
previously, MRI lumbar spine done 3 days ago
showed bulge disci D12-L1, L3-4, L4-5 and L5-S1.
There was weak dorsiflexion left foot and she
was treated conservatively. She came several
times and conservative treatment was suggested.
to the clinic 23-August-2004 complaining of LBP for
13 days with MRI
done the same day
showed huge extruded disc
L4-5 with left downward migration.
On examination: The patient is limping with
exaggerated scoliotic stance. SLRS was 50
degrees in the right and 20 degrees in the
left with pain. There is
drop left foot with weak dorsiflexion right foot 3/5 with hypalgesia
left L5 and S1 territories.
with neurolysis left L5 roots with
removal of the huge extrusion lateral to the axilla
from the left side. After
that, the root became lax and left 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 right foot became
normal, but the left drop foot still the same.
sent to the ward.
The patient came to the clinic 11-Septmber-2004
with clean wound and SLRS 80 degrees both sides
without pain and still having drop left foot.
The patient came several times then came 07-June-2008 complaining of
LBP with left sciatica for 3 weeks and MRI done
04-June-2008 showing left far lateral extrusion
L3-4. She was advised for surgery.
The estimated postoperative re-recurrence is still
ranking around 7%, because the disc space is
still relatively not shallow.