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24-APRIL-2010 SAMIRA AHMAD THAHER 63
YEARS EXTRUDED DISC L4-5 WITH RIGHT FORAMINAL OCCLUSION.
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Anamnesis
The
patient came
to the clinic 18-April-2010 complaining of
LBP with right sciatica for 6 months with
exacerbation last 2 weeks.
MRI
lumbar spine
performed 25-January-2010 showed extruded disc
L4-5 with right foraminal occlusion.
On examination: the
patient is limping with exaggerated scoliotic
stance. There is weak dorsi and planterflexion right
foot.
Decompressive laminectomy L4 and
partial of L5 was performed after checking for
instability elements, which were negative. Right L5
root foraminotomy. There was no epidural fat, due to
severe compression all over the field. Inspection of
the disc of L4-5 right side revealed
considerable compression to the root anteriorly,
which was removed by piece-meal resection. The root
became lax and free. Inspection of the disc space
which was severely narrow, for what it was not
violated.
Routine closure of the wound.
Smooth postoperative
recovery, with
full recovery of the
power of the right foot.
Comments
The patient has severe
compression of the right L5 root with agonizing
pain and weak right foot. The retrolisthesis at
this part of the extrusion could be a secondary
phenomenon due to the extrusion or an old one.
There was no signs of instability or
overmobility of any bony structures during the
operation.
The disc space was very
narrow (<1mm) , for what it was decided not to
violate the disc space.
Foraminotomy alone can
decompress the root, but removal of the
extrusion is better to make sure that there is
no postoperative source of pain.
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 .
