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209-NOVEMBER-2002 FATMEH ALI UTHMAN 67
YEARS EXTRUDED DISC L3-4 WITH LEFT DOWNWARD MIGRATION AND DROP LEFT FOOT.
Anamnesis
The patient came to the clinic
28-October-2002
complaining of LBP with left sciatica for 1
year. She was operated for PLD? 20 years ago.
Exacerbation the last 2 months. She has
rheumatoid arthritis, in cortisone and
methotrexat for 3 years. Hypertensive with
diabetes mellitus. MRI lumbar spine performed
09-October-2002 showing severe stenosis L3-4
with extruded disc L3-4 with left downward
migration.
On examination: The patient in agonizing pain,
limping with exaggerated scoliotic stance.
SLRS
60 degrees
with pain in the left. There is drop left foot
and severe weak planterflexion same foot, with hypalgesia left
L4,
L5 and S1 territories.
She was sent cardiologic consultation and to
stop cortisone and methotrexat.
Bilateral L4 foraminotomy with removal of the
extrusion lateral to the axilla from the left.
Left sided intradiscal cleaning L3-4. The
left huge downward migrating piece was removed. The patient was put in
Reverse Trendelenburg position with Valsalva
maneuver and hyperventilation. No CSF leak.
Routine closure of the wound.
Smooth postoperative recovery.
The power of the left foot still the same.
She was sent to the ward.
Follow Up
The patient came to the clinic 23-November-2002
with clean wound and still drop left foot with
hypalgesia left L5 root with
SLRS 90 degrees without pain both sides.
Comments
There is still an estimated postoperative
recurrence around 7%, because the disc space is still not
shallow.
The drop foot with these associated
factors will never recover.
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Notice: Head injuries and very urgent surgeries are also
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