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25-AUGUST-2007 INAAM FAYSAL UBEID 45 YEARS HUGE OLD EXTRUDED DISC L4-5 WITH
RIGHT DOWNWARD MIGRATION.
Anamnesis
The patient came to the clinic 16-August-2007
complaining of LBP for 17 years with right
sciatica for 2 months. MRI performed
26-July-2007 showing PLD L4-5 with right
downward migration.
On examination SLRS was 60 degrees in the right
side with weak dorsiflexion all toes right foot
and hypalgesia of the right L5 and S1
territories and scoliotic stance. The patient
had flue for what, she was advised to treat flue
first then undergo surgery.
Right L4-5 hemiflavotomy with foraminotomy of
right L5 root was performed. The root was
severely adherent to the extrusion and it was
abnormal in appearance such as it was split by
compression into 2 twigs, which were preserved
consequently. Meticulous cleaning of the
extrusion and the disc space from the right
side.
Routine closure and smooth postoperative
recovery and normalization of the power of the
right lower limb.
Comments
The patient had an old extrusion, which could
deform the running root and split it into two divisions above
the ganglion. It is rare to see such a picture.
From the above mentioned finding. it is
always necessary to seek the most lateral edge of the running
dura and start dissection from normal anatomy to the pathologic
one. This rule out producing destruction to the neural tissues.
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Notice: Not all operative activities
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