The patient came to the hospital 2 months after falling down complaining of LBP for 2 months with exacerbation last month with with right sciatica with pareasthesia and intermittent claudication. MRI lumbar spine performed 25-March-2004 showing extruded disc L4-5 with fracture of L5 with compression more the right side.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 15 degrees in the right and 80 degrees in the left with pain. There is weak dorsi and planterflexion right foot 4/5 with hypalgesia right L5 territory.

Foraminotomy right L5 root with removal of the extrusion lateral to the axilla from the right side. After that, the roots became lax and right sided intradiscal cleaning L4-5 disc space was done. Using miniscrews fusion of the flail L5 lamina was achieved and check for mobility was negative. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. A fat with pedicle was transferred from the subcutaneous layer and covered the exposed parts of the root, to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of right foot normalized.

The patient came to the clinic 10-April-2004 with clean wound and SLRS 85 degrees left side without pain and still weak dorsiflexion right foot4/5 and hypalgesia right L5 root.

The patient then came 11-September-2011  telling that the last 2 months got LBP and left sciatica down to the left knee. The patient was sent for investigations. MRI lumbar spine performed 13-Sptember-2011 showing bulge disci L1-2, 3-4 and L4-5. Dynamic studies were acceptable with the miniscrews in place.

The estimated postoperative recurrence is still ranking around 7%, because the disc space is still relatively not shallow.

This is the second surgery during which I am using miniscrews to fix the flail lamina of L5.