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16-AUGUST-2004 WALEED SULAYMAN HASAN 52 YEARS EXTRUDED
DISC L2-3, L4-5 AND L5-S1 WITH SEGMENTAL STENOSIS L4-5.
The patient a Qatari citizen came to the
clinic 05-August-2004 complaining of LBP with
bilateral sciatica, more the right for more than
2 years. Exacerbation last year and drop right
foot for more than 4 months. MRI lumbar spine
done 14-August-2004 showing huge extruded disc
L2-3, extruded disc L5-S1 with left downward
migration with elements of LCS L4-5. He is
diabetic for 8 years under
treatment and insulin dependent.
On examination, the patient in agonizing pain,
limping with exaggerated scoliotic stance with
drop right foot, weak dorsiflexion left foot 3/5
and planterflexion right foot. SLRS was 70
degrees with pain both sides with
pain. The right KJ is absent.
Through 2 separate incisions,
discectomy L2-3 with left sided cleaning.
Laminectomy L5 with decompression L4-5 with foraminotomy left
S1 root and discectomy L4-5 with removal of the
extruded disc and foraminotomy right L5 root. The patient was put in Reverse
Trendelenburg position with Valsalva maneuver
and hyperventilation. No CSF leak. The epidural
fat was transferred to the left axilla area. A fat was
harvested from the
subcutaneous layer with pedicle and transferred and covered the exposed parts
of the root to minimize postoperative
scarring. Routine closure
of the wound.
Smooth postoperative recovery. The right drop
foot still the same but the power of
the other muscles normalized.
came to the clinic 26-August-2004 with fever after
the third day of surgery, clean wound and improved
all muscles lower limbs except for the drop right
foot with no sensory deficit. SLRS was 80 degrees
with pain both sides.
There is still an
estimated postoperative recurrence around 7%,
because the disc space is still not completely