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22-NOVEMBER-2007 IMAD MUHAMED HABASH 36 YEARS HUGE EXTRUDED DISC L4-5 WITH
LEFT DOWNWARD MIGRATION.
Anamnesis
The patient came to the clinic 21-November-2007
complaining of LBP with left sciatica for 4
months. MRI performed 19-November-2007 showing
huge extruded disc L4-5 with left downward
migration.
On examination: the patient has exaggerated
scoliotic stance, limping with SLRS 45 degrees
in the right and 20 degrees in the left with
pain. He had weak dorsi and planterflexion left
foot and hypalgesia left L5 and S1 territories.
Left L4-5 hemiflavotomy with left L5 root
foraminotomy was performed. The extruded
fragment was completely covered by the root and
axilla, that it was impossible to remove it from
both routes. It was necessary to decompress the
disc space first, then to proceed with
piece-meal removal of the extrusion, pulling it
down to the disc space, after what the major
part of the extrusion could be caught and
removed, after what the root and the axilla
regained relaxed appearance. Meticulous cleaning
of the disc space from the left.
Routine closure of the wound and smooth
postoperative recovery with improvement of the
power of the left foot.
Comments
If the extrusion is fixed by the root and
the axilla, it is better to start decompressing the disc
space, after what the tension over the neural structures
decrease, permitting removal of the extrusion with minimal
traction injury to the neural structures.
The estimated recurrence rate in this
case must be minimal, since the disc space height is
minimal.
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