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The patient came to the clinic 3-October-2006 complaining of
LBP for 8 years with right sciatica. Exacerbation the last week with
positive cough sign. He was limping with scoliotic stance. On
examination: SLRS was 30 degrees in the right and 45 degrees in the
left with weak dorsiflexion right foot and hypalgesia right L5 and
S1 territories.
MRI lumbar spine performed 04-October-2006. It showed extruded
disc L5-S1 with right downward migration.
Right L5-S1 hemiflavotomy with foraminotomy of right S1
root was done. The extruded disc was removed and it was necessary to
violate the annulus fibrosis to remove the extrusion with further
cleaning of disc space from the right side. There was a small tear
in the root with small bulge of the arachnoid without CSF leak. It
was coagulated and the tear disappeared.
Routine closure of the wound.
Comments:
1. The disc space is narrow which is considered a good
predictor for lower rate of recurrence. The annulus fibrosis was
attacked for 8-9 mm wide which is a negative predictor.
2. The presence of dural tears must not be considered all the time
from surgery. They can be from severe compression in some points of
maximum compression. If they are small such in this case,
coagulation of the point or the tear is sufficient. |
