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28-DECEMBER-2002 TALEB MUHAMED ABDEL-RAHEEM
52 YEARS EXTRUDED DISC L3-4 WITH LEFT UPWARD MIGRATION.
Anamnesis
The patient came to the clinic 22-December-2002
complaining of LBP for 13 years with left
sciatica, deterioration last year with
exacerbation last month. MRI lumbar done
18-December-2002 showing huge extruded disc L3-4
with left upward migration. The patient is
hypertensive for 5 months.
On examination: The patient in agonizing pain,
limping with exaggerated scoliotic stance with
hypalgesia left L4,5 roots territory and weak
quadriceps femoris, dorsi and planterflexion
left foot 3/5. SLRS was 75 degrees with pain
left side.
The level of L3-4 was identified using the
C-arm. Left L3-4 hemiflavotomy with left L4
foraminotomy. The upward migrating piece was
followed and removed. Left sided intradiscal
cleaning of L3-4 disc space. The left L3 root
was also identified and released in the far high
point of the field. The patient was put
in Reverse Trendelenburg position with Valsalva
maneuver and hyperventilation. No CSF leak.
Routine closure of the wound.
Smooth postoperative recovery.
The power of the left lower limb improved.
He was sent to the ward.
Follow Up
The patient came to the clinic 04-January-2003
with clean wound and normal power and sensation
of the left lower limb, but complaining of
numbness of the right hand.
The patient then came several times, the last
was 12-May-2003 with OA left knee.
Comments
The recurrence rate of lumbar disc is
around 7%, because the disc space is still not shallow.
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Notice: Head injuries and very urgent surgeries are also
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