The patient came to the clinic 22-December-2007 complaining of LBP for 2 years. Exacerbation of left sciatica the last 11 days down to left L5 root territory and positive cough sign.

MRI of bad quality performed 11-July-2004 showed extruded disc L4-5 with left upward migration.

The patient is limping with exaggerated scoliotic stance with SLRS 45 degrees in the right and 30 degrees in the left with hypalgesia left L4 and L5 territories and almost drop left foot.

The patient was sent for new MRI, which showed left L5-S1 disc extrusion with downward migration.

Left S1 foraminotomy was performed and left L5-S1 hemiflavotomy was achieved. The extrusion was removed from under the axilla. Minimal cleaning of the disc pace was performed from the left side.

Smooth postoperative recovery.

 

Minimal cleaning of the intradiscal space proved to heighten the incidence of recurrence, so that, it is preferable to perform intradiscal cleaning of the sequestered material inside the disc space, after removing the extrusion, but here the disc material was looking healthy, for what minimal cleaning was limited.

The epidural fat was acceptable and was kept and preserved until the end of the operation.
The disc space of this patient is not narrow and the cleaning was performed minimally and the defect in the annulus fibrosis was minimal, which could predict an estimated incidence of 7% recurrence rate.

All the time, do not hesitate to ask for new MRI, if the previously performed MRI is of bad quality or an old one. The morphologic data could be different and mistakes could be avoided by following such policy.