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23-AUGUST-2010 HEGER ABDALLAH SALEM 65 YEARS
LUMBAR CANAL STENOSIS L2-3 AND L3-4 WITH EXTRUDED DISC L4-5 WITH RIGHT FAR
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to the emergency of Shmaisani hospital
22-August-2010 complaining of agonizing right
sciatica for one week. The patient was
complaining of difficult walking for several
years with intermittent claudication. She was
operated by me for PLD L5-S1 15 years ago.
MRI lumbar spine
performed 21-August-2010 showing extruded disc
L4-5 with right far downward migration and
lumbar canal stenosis L2-3 and L3-4.
On examination: the
patient is unable to stand and cannot lay supine
for examination. SLRS was 20 degrees in the
right with pain with almost drop right foot and
analgesia right L5 and S1 root.
laminectomy L2-3-4 and scarolysis at the level
of previously removed L5 lamina. The dura was
very thin with mesh-like perforations of the
dura which were repaired by nylon 6 zero.
Foraminotomy of right L5 root was achieved. The
lateral wall of the root was also with dural
defect, which was also repaired. The far
extruded disc was removed from under the axilla
in several fragments, after what the root was
free of compression. The shallow disc space of
L4-5 was approached lateral to the axilla and
the disc space was cleaned from the right. The
head was positioned up and Valsalva maneuver was
applied to check for CSF leak. It was negative.
Two pieces of muscles were applied over the
dural defects to further insure the avoidance of
postoperative CSF leak.
Routine closure of
the wound and smooth postoperative recovery with
improvement of the power of the right foot and
disappearance of right sciatica.
The estimated postoperative
recurrence rate in this case is around minimal
because the disc space height is very shallow.
The extruded disc was far
migrating down and separated from the disc space
and it was necessary to remove it from under the
scarrous right L5 axilla.
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 .