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Multigen RF lesion generator .
08-DECEMBER-2003
FATMEH MAHMOUD AL-RIFAI 42 YEARS EXTRUDED DISC L5-S1 WITH LEFT UPWARD MIGRATION.
Anamnesis
The patient came to the clinic 07-Deecember-2003 complaining of
LBP with Left
sciatica for 7 months with
numbness of the left foot with positive cough
sign.
MRI lumbar spine done 29-November-2003 showing
huge extruded disc L5-S1 with left upward migration.
On examination: The patient is limping with
exaggerated scoliotic stance. SLRS was 90 degrees
in the right and 60 degrees in the
left with pain. There is
weak dorsiflexion left foot 3/5.
Left S1 foraminotomy with
subaxillary removal of the extrusion. After
that, the root became lax and left sided
intradiscal cleaning L5-S1 disc space was done.
The patient was put in Reverse Trendelenburg
position with Valsalva maneuver and
hyperventilation. No CSF leak. A free fat was
harvested from the subcutaneous layer and
covered the exposed parts of the root. to
minimize postoperative scarring. Routine closure
of the wound. Smooth postoperative recovery. The
power of the left foot became normal.
FOLLOW UP
The patient came to the clinic 13-December-2003
with clean wound and SLRS 90 degrees right side
and 75 degrees left side
with pain and no motor, nor sensory deficit.
The patient then came several times and the last
time with MRI performed 06-June-2006 showing
small recurrence of L5-S1, not in need for
surgery. She was treated conservatively.
Comments
The patient had huge extrusion of L5-S1 without
improvement. Surgical intervention is the only
solution.
The estimated postoperative recurrence is still
ranking around 7%, because the disc space is
still relatively shallow.
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Notice: Head injuries and very urgent surgeries are also
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