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25-AUGUST-2004 NIDAL IBRAHEEM AL-HAMAD 33
YEARS RIGHT EXTRUDED DISC L4-5.
The patient a doctor, came
to the clinic 19-July2003 complaining of LBP for
5 years with right sciatica for 6 months. MRI
showed huge extruded disc
L4-5 with right downward migration.
On examination: The patient is limping with
exaggerated scoliotic stance. SLRS was 50
degrees in the right and 80 degrees in the
left with pain. There is
weak dorsiflexion right foot 3/5 with hypalgesia
right L5 and S1 territories.
right L5 roots with
removal of the huge extrusion lateral to the axilla
from the right side. After
that, the root became lax and right 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. He was
sent to the ward.
The patient came to the clinic 05-Septmber-2004
with clean wound and SLRS 80 degrees both sides
without pain and neurologically free.
The patient came 08-April-2017 complaining of
LBP with right sciatica for 1 month and
neurologically he was free. He was sent for MRI
lumbar spine and done 09-April-2017 showing
small recurrence at L4-5. He was treated
conservatively and improved.
The estimated postoperative recurrence is still
ranking around 7%, because the disc space is
still relatively not shallow.