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17-APRIL-2008 SHAREEF
SULAYMAN AL-ATTAWNEH 52 YEARS EXTRUDED DISC L4-5 WITH
LEFT DOWNWARD MIGRATION.
Anamnesis:
The patient came to the
clinic 15-April-2008 complaining of severe left
sciatica for 4 days with LBP and numbness of
left L5 territory.
The patient was operated 1981
for PL L5-S1 with left sciatica. He was operated
another time by me
01-October-2003 for
recurrence at the same level.
The patient then came
26-September-2007 with exacerbation of the left
sciatica and hypalgesia of left S1 root. MRI of
the lumbar spine performed 27-September-2007
showed small extrusion of L4-5 left side and no
recurrence at L5-S1 level. The patient was
advised to undergo conservative treatment.
SLRS was 80 degrees in the
right and 40 degrees in the left with pain.
Limping when walking and exaggerated scoliotic
stance. He had weak dorsiflexion left foot.
MRI of the lumbar spine
performed 16-April-2008 showed extruded disc
L4-5 with left foraminal occlusion and downward
migration.
Left L4-5 hemiflavotomy with
left L5 root foraminotomy was done. The extruded
disc was removed lateral to the axilla and left
sided cleaning of the L4-5 space was achieved.
Routine closure of the wound
with smooth postoperative recovery.
Considerable improvement of the
power of the left foot.
FOLLOW UP
The patient
came to the clinic 30-April-2008 with clean wound
with still weak dorsiflexion left foot 4/5. SLRS was
80 degrees left
side without pain.
The patient
then came 06-November-2011 telling that the last 2
days got LBP without sciatica and no motor nor
sensory deficit. He was treated conservatively.
Comments
The disc space height is
still considerable, for what meticulous cleaning
was performed to decrease the expected
recurrence rate, which still remaining above the
average.
The presence of previous
surgeries usually make protracted period of
postoperative recovery.
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