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03-APRIL-2012 MAJD
HUSSEIN ISSA ABDEL-MAHDY 35 YEARS HUGE EXTRUDED DISC
L5-S1 WITH MORE TO THE RIGHT EXTRUSION.
Anamnesis
The
patient was transferred from other
hospital to Shmaisani hospital 02-April-2012
with history of LBP for 6 months with
exacerbation the last 3 days with agonizing
bilateral sciatica more to the right.
MRI lumbar spine performed 31-March-2012
showing huge extruded disc L5-S1 with right foraminal
and downward migration.
On
examination, the patient in agonizing pain
unable to stand or walk. SLRS was 5
degrees in the right and 15 degrees in the left
with shooting pain. The right AJ is absent. There
is profound weakness right foot dorsi and
planterflexion -3/5. There is hypalgesia right L5
and analgesia right S1 territories.
Bilateral foraminotomy of S1 roots. The extruded
disc was removed first from the right side. Left
sided removal was followed, then bilateral
cleaning of the L5-S1 disc space was achieved.
The calcified movable parts of the deformed
annulus fibrosis were removed also. The epidural
space was flush with Guardix-sol 1.5 g.
Routine
closure of the wound. Smooth postoperative
recovery. The power of both feet became
normal.
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Comments
The estimated
postoperative recurrence rate still around 7%,
because the disc space is still not shallow.
In this case bilateral
removal of the extrusion was mandatory.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .