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11-JULY-2010 SAMEER MAHMOUD ABED AWAD 37 YEARS
RECURRENT PLD L4-5 LEFT SIDE.
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admitted to Shmaisani hospital 09-July-2010
complaining of agonizing left sciatica and
almost drop left foot.
The patient was
operated at UH 26-June-2010 for extruded disc
L4-5 left side without improvement, in the
contrary with clinical deterioration.
MRI of the lumbar
spine performed 09-July-2010 showing recurrence
of L4-5 left side with complete occlusion of the
foramen of left L5 root. Lab investigations
ruled out the presence of infection.
On examination: the
patient in agonizing pain with left sided
sciatica and inability to walk. There is drop
left foot with weak planterflexion left foot
4/5. There is hypalgesia left L5 territory. SLRS
was 5 degrees in the left with pain.
The upper half of
the wound was refreshed and the left upper
corner of the L5 laminar defect was drilled out
and the remnants of the ligamentum flavum
were removed. Scarolysis of the compressed left
L5 root was done and foraminotomy of the left L5
root was performed. The extruded disc was
removed lateral to the axilla in several pieces
and meticulous cleaning of the L4-5 disc space
was achieved. Inspection of the root and
subaxillary region was done to rule out
migrating fragments. The root was hanging free
at the end of the operation.
Routine closure of
the wound and smooth postoperative recovery.
The power of the
left foot dramatically improved and the left
Recurrence of the lumbar disc
can happen even immediately after turning of the
patient from the operating table. It can happen
even after 30 years after surgery.
In my practice, it happened
twice that in the recovery room, when the
patient demonstrating that he has still
agonizing sciatica without improvement of his
neurological deficit, the patient was sent back
to the operating room, and the wound was
reopened to find a huge recurrence, which was
removed accordingly. One of the patient even did
not remember that he underwent 2 surgeries at
the same time.
It is wrong to consider
recurrence as complication of lumbar disc
surgery. It is part of the problem and it
happens in 7-15% of cases according to several
The surgeon must explain to
the patient about this possibility to avoid
future postoperative conflicts.
Using PEEK Satellite sphere
of Medtronic was abandoned by us because it
caused severe reactionary changes of the
adjacent vertebral bodies due to pressure
necrosis of both endplates.
The patient still have the
possibility of another recurrence, because the
disc space still not shallow. The estimated
recurrence in this case still ranking around 7%.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .