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17-FEBRUARY-2007 BASSAM MUHAMED ISMAEEL 44 YEARS HUGE BILATERAL EXTRUSION
L4-5 WITH OLD CALCIFIED EXTRUSION L5-S1 RIGHT SIDE.
Anamnesis
The patient came to the clinic 15-February-2007
complaining of LBP for 20 years with bilateral
sciatica more the right for one month.
MRI lumbar spine done 06-February-2007 showed a
very huge bilateral extrusion of L4-5 disc with
an old disc bulge L5-S1 right side.
On examination: the patient had scoliotic stance
with SLRS 80 degrees both sides. There was weak
dorsiflexion both feet 4/5 and planterflexion
right foot 4/5 with stiff back upon bending.
Bilateral foraminotomy of both L5 roots with
attacking the lesion from the right. The huge
extruded fragment was impossible to remove from
the right side. Attempts were tried from the
left side and the huge extrusion was removed
from the left side, after what the roots became
relax and free. Bilateral cleaning of the disc
space was achieved.
Routine closure and smooth postoperative
recovery and improvement of the power of both
feet.
Comments
The clinical picture was more striking in
the right leg, but the huge fragment was hidden in the left.
It could be explained, that the mobile and less compressed
part of the neural structures were manifesting themselves
and the stuck without motion, was clinically silent.
When bilateral extrusion having place,
bilateral cleaning and inspection is a must and meticulous
cleaning of the disc space must be performed.
The incidence rate of recurrence here is
around 7%.
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