The patient came to the clinic 08-March-2007 complaining of LBP for 5 years with left sciatica. Exacerbation of the LBP with left sciatica the last 10 days with numbness of the left L5 and S1 roots.

On examination: The patient is limping and has scoliotic stance. SLRS was 80 degrees in the right and 50 degrees in the left. The left AJ is absent with analgesia for pin-brick at the left S1 root territory. There is weak planter and dorsiflexion left foot 4/5.

MRI of the lumbar spine performed 05-March-2007 , showing huge extrusion L5-S1 with severe compression of the left S1 root.
Left L5-S1 hemiflavotomy with left S1 foraminotomy was performed. The root was severely compressed from anterior and it was impossible to reach the extrusion from under the axilla. The upper most parts of the extrusion was fragmented and removed from lateral the axilla, after what the major portion came out.
Inspection of the annulus fibrosis, showed a small defect and the intradiscal material was strong by inspecting it using a very tiny Swedish. It was decided not to violate the disc space, since the space is narrow. Routine closure.

Smooth postoperative recovery and normalization of the power of the left foot.

 

The extruded disc large enough, and the root was severely compressed by the extruded and downward migrating piece, causing complete loss of the function of the left S1 root.

So as to avoid surgical trauma to the already traumatized root, it was necessary to fragment the upper most of the extrusion to regain ample to shift the nerve to remove the big extrusion. Avoidance of surgical trauma to the neural structures, make postoperative deterioration of them a rarity.

Considering that the disc space is narrow and the defect in the annulus fibrosis is small and the disc material is hard, it was decided to leave the disc space untouched.