The patient came from YAR to the clinic 31-March-2007 complaining of agonizing left sciatica for 2 months with escalation the last week and numbness of the left L5 and S1 roots territory. The patient was operated 25 years ago for PLD L4-5 in UK.

MRI of the lumbar spine performed 24-March-2007 showing extruded disc L5-S1 with no recurrence at L4-5 level. The MRI was of bad quality.

On examination: the patient walking with aid and crutches. The patient is limping and has scoliotic stance. SLRS was 35 degrees in the right and 5 degrees in the left. The left AJ is absent in the left with analgesia for pin-brick at the left S1 root territory and hypalgesia of the L5 territory. There is weak dorsiflexion left foot 4/5.

The patient was sent for new MRI of the lumbar spine, which was performed and more clearly demonstrated the extrusion and the left side downward migration of the piece.

Left L5-S1 hemiflavotomy with left S1 foraminotomy was performed. The root was severely compressed from anterior and it was necessary to perform discectomy of L5-S1 to regain some ample and to withdraw the extrusion back to the disc space cavity, after what it was possible to remove the extrusion in one piece lateral to the axilla. Further cleaning of the disc space was performed from the left side. The root regained relaxed position. Routine closure.

Smooth postoperative recovery and normalization of the power of the left foot.


 

The extruded disc was not large enough, but the root was severely compressed by the extruded and downward migrating piece, causing complete loss of the function of the left S1 root.

So as to avoid surgical trauma to the already traumatized root, it was necessary to decompress the disc material, then the extrusion was removed, after pushing it inside the disc space. Avoidance of surgical trauma to the neural structures, make postoperative deterioration of them a rarity.