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20-JUNE-2007 NAJAH ABDEL-HAMED ABDEL-DAYEM 49 YEARS HUGE
EXTRUDED LEFT DOWNWARD MIGRATING DISC L5-S1.
Anamnesis
The patient came to the clinic 19-June-2007 with
agonizing LBP with left sciatica for 1 month
with escalation the last week, with the help of
2 persons to walk and inability to lay supine.
It was impossible to evaluate her for scoliotic
stance and Romberg positioning.
On examination: SLRS was 45 degrees in the right
and 5 degrees in the left. Severe weak dorsi and
planterflexion left foot with hypalgesia both
left L5 and S1 roots territories.
Left L5-S1 hemiflavotomy with foraminotomy of
left S1 root. The root was hemorrhagically
embedded and the extruded disc was removed from
under the axilla. It was removed in several
pieces. After the root became relax, cleaning of
the remaining extrusion at the level of the
annulus fibrosis was achieved lateral to the
axilla with meticulous intradiscal cleaning.
Routine closure with smooth postoperative
recovery and normalization of the power of the
left foot.
Comments
The patient had hemorrhagic changes in the
root, which means that the root was exposed to certain trauma
after extrusion, which explain the agonizing pain. The extruded
downward migrating pieces were able to be removed from under the
axilla. After that it was possible to proceed with intradiscal
cleaning.
Her son is a surgeon and he assisted me in
her surgery.
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