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05-NOVEMBER-2007 TARIQ IBRAHEEM AL-TARAWNEH 33 YEARS EXTRUDED
DISC L4-5 RIGHT SIDE.
Anamnesis
The patient was operated by me
04-Noveber-2004
for PLD L5-S1. The patient improved, then
reappeared 05-March-2007 complaining of LBP with
MRI performed 04-March-2007 showing dehydration
of L4-5 and L5-S1 without signs of recurrence.
He was neurologically free at that time. MRI
lumbar spine done 22-October-2007 showing
extruded disc L4-5 with right extrusion. The
patient came to the clinic 31-October-2007 with
the performed MRI.
On examination: the patient has scoliotic stance
with weak dorsiflexion right foot. SLRS was 40
degrees right side.
Right L4-5 hemiflavotomy with right L5 root
foraminotomy was performed. The extruded disc
was attacked lateral to the axilla. It was
removed in several pieces and meticulous
cleaning of the disc space of L4-5 was done from
the right side. No attempt was paid to widen the
defect in the annulus fibrosis.
Smooth postoperative recovery with normalization
of the power of the right foot.
Follow Up
The patient came to the clinic 19-November-2007
with clean wound, normal power and sensation.
The patient then appeared 10-February-2008 with
LBP for 3 weeks with cramps both lower limbs. He
was treated conservatively and disappeared.
Comments
The patient underwent surgery for PLD
L5-S1 3 years ago. No recurrence was noted up today, but he
got PLD L4-5 which was small 8 months ago in the MRI
findings.
It could be that the patient had the same
problem 8 months ago and the static MRI was not showing the
extrusion, since the patient was investigated in supine
position. It could be that there was an extrusion and if the
patient performed the MRI in the sitting position, the
extrusion could be caught.
These speculations hold the importance of
performing dynamic MRI.
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