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The patient came to the clinic 22-November-2006 complaining
of
LBP for 10 years with left sciatica. The last 4 months, he
progressed severe right sciatica. MRI performed 30-October-2006
showed extruded disc L4-5 with right downward migration and
dehydrated L5-S1 with lumbarization of S1.
On examination: the patient was limping with scoliotic stance
with SLRS 45 degrees in the right, weak dorsiflexion all toes right
foot, stiff back when bending.
Right L4-5 hemiflavotomy with right L5 root foraminotomy were
preformed and the extruded disc material was removed in 2 pieces
lateral to the axilla. The defect in the annulus fibrosis was not
small and the disc space was cleaned from the right until the
sequestrated material was removed. Minimal cleaning was
intentionally achieved.
Smooth postoperative recovery.
Comments:
1. The disc space is relatively high and the defect in the
annulus fibrosis was not small. The expected recurrence is
relatively higher than the usual.
2. All the running epidural veins were preserved. The good
venous flow around the root indirectly confirm the absence of
pressure at the foramen. The epidural fat was transferred to
the root to lower the postoperative scar formation. |
