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The patient came to the clinic
one moth ago with clinical picture of LBP for several months and
right sciatica. The patient had weak dorsiflexion right foot with
hypalgesia of the right L5 territory with intermittent claudication.
MRI performed and showed elements of segmental stenosis L4-5 with
extruded disc L4-5 with right downward migration. The
condition of the patient was not striking for surgery and it was
recommended to give a trail for conservative treatment.
The patient then came after one month and she was
claiming that, her condition is deteriorating and she became unable
to ambulate, despite the conservative measures.
The patient then was operated. Bilateral
flavotomy of L4-5 with right L5 foraminotomy was done. The extruded
piece was removed from under the axilla and the disc space with
wide-based fragment was removed from the right side with meticulous
cleaning of the disc space.
Comments:
1. After removal of the extrusion from under the
axilla, the nerve was still tight with annulus fibrosis still
compressing the nerve from behind. Despite the fact that it was
glistening, but the wide-based extrusion was sharing the compressing
elements in the root from anterior, for what cleaning of the disc
space was performed.
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