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Multigen RF lesion generator .
01-DECEMBER-2003 HURIYE ALI NASSAR
38 YEARS EXTRUDED DISC L4-5 WITH LEFT UPWARD MIGRATION.
Anamnesis
The patient came to the clinic 29-nOVEMBER-2003 complaining of
LBP with Left
sciatica the last 19 days with
numbness of the left foot.
MRI lumbar spine done 11-November-2003 showing
huge extruded disc L4-5 with left upward migration.
On examination: The patient is limping with
exaggerated scoliotic stance. SLRS was 90 degrees
in the right and 70 degrees in the
left with pain. There is
weak dorsiflexion and
planterflexion left foot 3/5 with hypalgesia
left L5 territory.
Left L5 foraminotomy with
subaxillary removal of the extrusion. After
that, the root became lax and left sided
intradiscal cleaning L4-5 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 both sides
without pain and no motor, nor sensory deficit.
The patient then came several times with neck
pain and another time with knees problems and
check MRI lumbar spine done 30-May-2012 showing
no recurrence and bulge disci C4-5, 5-6 and
C6-7.
Comments
The patient had huge extrusion of L4-5 without
improvement. Surgical intervention is the only
solution.
The estimated postoperative recurrence is still
ranking below 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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