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The patient came urgently to the operating room complaining of
LBP for 8 years with right sciatica. Exacerbation the last month with
positive cough sign. He was limping with scoliotic stance. On
examination: SLRS was 30 degrees in the right and 45 degrees in the
left with weak dorsiflexion right foot and hypalgesia right L5 and
S1 territories.
MRI lumbar spine performed 06-October-2006. It showed extruded
disc L4-5 with right downward migration.
Right L4-5 hemiflavotomy with foraminotomy of right L5 root
was done. The extruded disc was removed and it was necessary to
violate the annulus fibrosis to remove the extrusion with further
cleaning of disc space from the right side.
Routine closure of the wound.
Comments:
1. The patient came with agonizing pain. It was caused by the
sequestrated disc material, which was compressing the root with
mobility of the fragments. Mechanical irritation played an integral
part in his pain generation. |
