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13-FEBRUARY-2007 RANA MASH-HOOR AL-ASSAF 27 YEARS EXTRUDED DISC L5-S1 WITH
LEFT UPWARD AND RIGHT DOWNWARD MIGRATION.
Anamnesis
The patient came to the clinic 03-February-2007
complaining of LBP with left sciatica for 2
months.
MRI lumbar spine done 23-January-2007 showed
prolapsed lumbar disc L5-S1 with bilateral
extrusion with left upward and right downward
migration.
On examination: the patient had exaggerated
scoliotic stance and limping during walk. SLRS
was 30 degrees in the left with pain. Weak
dorsiflexion all toes left foot.
Bilateral foraminotomy of both S1 roots was
performed and the left root was inspected and
the extrusion was removed under the left axilla.
The contralateral disc surface was checked for
extrusion. There was still a huge extrusion, for
what the extrusion was removed and bilateral
cleaning of the disc space was performed
meticulously. Epidural fat transfer to minimize
postoperative scar formation and give the roots
more natural anatomy. Routine closure with fat
transfer
Smooth postoperative recovery and normalization
of the left foot power.
Comments
The disc space was wide and the disc
material was removed meticulously. These factors make the
incidence of recurrence around the average of 7%.
Despite the fact, that the disc extrusion was migrating
upward in the left, but for certain anatomical relationship,
the removal was done from under the axilla. The right
downward migrating part was removed lateral to the right
axilla. This was done to minimize the surgical trauma with
minimal traction of the roots during surgery.
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