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The patient came 13-August-2006 complaining of LBP for 6 months
with left sciatica for 1 month and numbness left L5 territory. MRI
done 05-August-2006 showing huge extruded disc L4-5 with left
downward migration and bulge L5-S1. On examination: SLRS was 20
degrees in the left with pain with exaggerated scoliotic stance and
drop left foot. The patient was advised to undergo surgery.
Left L4-5 hemiflavotomy with left L5 root foraminotomy was
performed and the axilla was inspected, under which the downward
migration was seen and removed from there, after what the root
became relaxed. The root then was shifted medially and the old
centrally extrusion was removed with further cleaning of the disc
space was done.
Prompt postoperative recovery.
Comments: 1. Considering
that the old part of the extruded disc in the central localization
was mobile, it was necessary to attack the disc space lateral to the
axilla to perform intradiscal cleaning to gain more relief of the
root. This step could increase the rate of recurrence, but it was
necessary to do to obtain maximum decompression of the root. |
