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11-JULY-2007 IBTISAM AHMAD ABDALLAH 44 YEARS EXTRUDED DISC L5-S1 WITH LEFT
DOWNWARD MIGRATION.
Anamnesis
The patient is a known insulin dependent
diabetic, came to the clinic 09-July-2007,
complaining of LBP for 4 years with left
sciatica the last 2 months with numbness of left
S1 territory.
MRI lumbar spine performed 07-July-2007 showed
extruded disc L5-S1 with left downward
migration.
On examination: the patient in agonizing pain
and SLRS 50 degrees in the right, shooting to
the left and 30 degrees in the left. The AJ was
absent in the left with weak dorsi and
planterflexion left foot with hypalgesia of the
left L5 and S1 roots territories.
Left L5-S1 hemiflavotomy with left S1
foraminotomy was achieved. Small part of the
extruded disc was removed lateral to the axilla,
but the major part was removed subaxillary.
Meticulous cleaning of the disc space was
performed from the left side.
Routine closure of the wound and smooth
postoperative recovery.
Comments
The left L5 root was seen running parallel to
the left S1 root. It could be a normal variant or an accessory
nerve, which explain the wide spread involvement of the
neurological deficit.
The motor fibers recover immediately after the operation.
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