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The patient came
to the clinic 12-October-2006 complaining of agonizing left
sciatica for one month. She came 2002 with right sciatica and MRI
was requested at that time but she escaped from the clinic. On
examination, the patient could walk only with help with exaggerated
scoliotic stance and she could not be able to take the supine
position for examination. On examination: SLRS was 5 degrees in
the left and 45 degrees in the right with almost drop left foot with
weak planterflexion. She had hypalgesia of the left L5 and S1
territories. MRI was asked and performed, showing very huge disc
L5-S1 with left downward migration with lumbarization of the sacrum.
Bilateral S1 foraminotomy was performed and the huge extruded
disc was removed lateral to the left S1 axilla was removed in one
piece. Inspection of the right side was negative for remnants and
inspection of the annulus fibrosis was glistening without presence
of obvious defect. Considering that the disc space was narrow and
the possibility for recurrence is low, it was decided not to perform
intradiscal cleaning. Routine closure and smooth postoperative
recovery.
Comments:
1. Considering that the extrusion was very huge and the disc
space was narrow, the possibility for recurrence is low, for what
the intradiscal space was not violated.
2. Intradiscal cleaning must be performed when the disc space is not
narrow, even if the annulus fibrosis is glistening, because there
are recurrences in such situation. |
