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The patient came to the
clinic with complains of right sciatica and numbness of the left
foot with inability to walk more than 100 meter. MRI performed 18
months ago showed huge PLD L5-S1. On examination, the patient had
bilateral drop feet with sciatica more pronounced in the right side
and hypalgesia both L5 and S1 roots. Repeat MRI showed the same
picture.
Bilateral L5-S1 flavotomy with bilateral
foraminotomy of both S1 roots was performed and the extrusion was
removed from both sides and cleaning of the disc space was done from
both sides. It was interesting that the disc material was migrating
behind the cul de sac from the right side and this part was removed
from the epidural fat behind the right S1 root.
Comment:
Here is a case, that minimal cleaning of the disc
space is impossible, because all the time the disc material was
coming from the disc space and it was impossible to leave fragments
in the space. In the other side, attempt was made to preserve the
integrity of the lateral wall of the annulus fibrosis, to prevent
possible collapse of the disc space. It is the second case in the
same day rising the challenge, that the concept of trying to leave
as much as possible in the intradiscal space to prevent future
collapse. The conclusion that, this task is hard to achieve in very
huge extrusion of the disc material with bilateral extrusion.
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