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24-OCTOBER-2012 UMAR ABDEL-LATIF AL-BASHITI 55
YEARS HUGE EXTRUDED DISC L5-S1 WITH RIGHT UPWARD MIGRATION.
Anamnesis
The patient came to the clinic 22-October-2012
complaining of agonizing LBP with bilateral
sciatica for the last 10 days, more during
night. He cannot walk more than 100 meters with
difficulty and pain. The patient was operated by
me for huge extruded disc C4-5, C5-6
06-September-2012 through anterior approach.
The patient improved from his quadriplegia. The
patient then came with clinical deterioration
21-March-2011 with difficult walking the last 2
weeks and investigations confirmed the
presence of cervical stenosis, for what, he was
operated
26-March-2011 by decompressive laminectomy
C4-5-6 and partial of C7. The patient then got
improvement with good power of four limbs but
with persistent sensory deficit of the lateral
aspect of the right upper limb and below the
left Th10. The patient then came 23-May-2012
complaining of general weakness and heaviness in
walk with LBP. MRI of the cervical spine was
uneventful, and the MRI of the lumbar spine
27-May-2012 showed bulges of L3-4, L4-5 and
L5-S1. The patient was treated conservatively
and the power of the four limbs were at that
time 5/5.
On examination: the patient was limping with
scoliotic stance. SLRS was 30 degrees with pain
both sides. There is almost drop right foot with
weak planterflexion right foot -3/5 and
dorsiflexion left foot -4/5 and planterflexion
left foot 4/5. There is analgesia of the left L5
root. Both quadriceps are weak 4/5.
The patient was sent for whole spine
investigation and done 23-October-2012 showing
huge extruded disc L5-S1 with right upward
migration.
Right L5 partial hemilaminectomy with
preservation of ligamentum flavum, which was
reflected to the left. The huge extrusion was
removed lateral to the axilla in several big
pieces. The L5-S1 disc space was shallow any
empty from any disc material.
Routine closure of the wound. Smooth
postoperative recovery with normalization of the
power of the left foot and improvement of the
power of the right foot.
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Comments
The patient has an
estimated postoperative recurrence below 7%,
because the disc space is shallow and empty.
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