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The patient came to the clinic 04-October-1998 with LBP and
right sciatica for 3 years after RTA. In MRI data and on examination
at that time he showed an extruded disc L4-5 and was operated. He
then came 28-April-1999 with clinical signs of recurrence and MRI
showed a huge recurrence, for what he was operated 16-May-1999 for
the recurrence.
The patient then came 17-September-2006 with LBP and right
sciatica for the last week. On examination, SLRS was 30 degrees in
the left and 45 degrees in the left with hypalgesia below the right
knee. There was no motor deficit and the MRI performed
11-December-2006 showed only bulge disc L3-4. The patient was
advised for conservative treatment.
The patient then came 11-November-2006 claiming that he was doing
well , but deteriorated the last week. On examination: he was
limping with scoliotic stance with SLRS 5 degrees in both sides.
He had hypalgesia below knees both lower limbs and severe weak dorsi
and planterflexion both feet 3/5. MRI performed
05-December-2006 demonstrated a huge extrusion of L3-4.
The patient was operated: laminectomy of both L3 and 4 was
performed and bilateral L4 foraminotomy was done and the disc
extrusion was removed lateral to the right axilla. Cleaning of the
disc space was performed from the right. Inspection of the disc
space from the left was negative.
Smooth postoperative recovery.
Comments:
1. Most of the population above the age of 16 years have
discopathy. Here is a demonstration of how to deal with the case,
when to operate for de novo extrusion and for recurrence and when
another time to attack the other de novo extrusion. |
