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18-DECEMBER-2007 IBRAHEEM ABDEL-MUEEN HUSSEIN 44 YEARS BILATERAL EXTRUDED
DISC L5-S1 WITH OLD LEFT AND RECENT RIGHT HUGE EXTRUSION.
Anamnesis
The patient came to the clinic 16-December-2007
complaining of left sciatica and LBP for 3
years. Exacerbation of right sciatica the last
15 days with numbness right foot and perianal
region. MRI done 12-October-2004 showed an
extruded disc L5-S1 with left sided extrusion.
On examination: the patient had weak
dorsiflexion right foot 3/5 and left foot 4/5,
weak planterflexion both feet 4/5 with
hypalgesia right S1 territory. The patient was
sent for another MRI lumbar spine, which
revealed new huge extruded disc L5-S1 right side
with downward migration.
Bilateral S1 foraminotomy was performed and the
left extruded disc was removed in piecemeal
fashion and bilateral cleaning of the disc space
of L5-S1 was performed.
Routine closure of the wound and smooth
postoperative recovery.
Comments
The patient has bilateral extruded disc
with early signs of cauda equina syndrome. Bilateral
cleaning of L5-S1 was the proper choice in his surgical
planning for two reasons. First: to eliminate all the
compressive elements, Second: to decrease the rate of
recurrence.
The recurrence rate in this case is below the average - 7%
because, the disc space is shallow and bilateral meticulous
cleaning was performed.
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