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The patient came
to the emergency of Al-Shmaisani Hospital 27-October-2006 with
agonizing pain with severe right sciatica for 10 days after lifting
heavy object in YAR. MRI performed today showing a huge recurrence
at L5-S1 with right up and downward migration. The patient was
operated by me 4 years ago. On examination: the patient had almost
drop right foot with hypalgesia of right S1 territory. Positive
cough sign. Other clinical examination was impossible to perform due
to pain.
The patient was urgently taken to the operating room and right S1
foraminotomy was performed and the scar was removed from the right
side and the extruded large disc material was removed in one piece.
Inspection of the annulus fibrosis for remnants of extrusion was
negative. The disc space was not violated intentionally.
Routine closure and smooth postoperative recovery.
Comments:
1. Considering that the extrusion was very huge and the disc
space is shallow, the recurrence after such surgery must be minimal.
2. Second recurrence could have place in 7% of patients, how
underwent second surgery for recurrence. This can happen if the same
factors, which increase the recurrence for the first time, could
play a role in triggering the recurrence the next time.
3. The cause of recurrence in this case was vigorous physical
effort. The operated disc patients must avoid such physical
effort for minimum 10 years. |
