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08-DECEMBER-2007 ZAYNAB SALEH HAMMAD 54 YEARS HUGE EXTRUDED DISC L2-3 WITH
CENTRAL AND LEFT UPWARD AND LEFT FAR-LATERAL EXTRUSION WITH OA RIGHT KNEE.
Anamnesis
The patient came to the clinic 05-December-2007
complaining of LBP with bilateral sciatica for 3
years and right knee pain for three months.
On examination: the patient limping with
exaggerated scoliotic stance, with agonizing
sciatica. SLRS was 30 degrees in the right and
45 degrees in the left. There was weak
dorsiflexion both feet 4/5 and planterflexion
right foot 4/5, with osteoarthritis both knees
with pain of the right knee. MRI performed
05-December-2007 showing huge extruded and
sequestrated disc L2-3 with central and left
upward and left far-lateral extrusion.
Under image-intensifier, the L2-3 was identified
and left hemiflavotomy of L2-3 was performed and
foraminotomy of left L3 root was achieved. The
extruded part was removed lateral to the axilla
and the far-lateral pieces were removed and the
upward migrating piece was removed separately.
Meticulous cleaning of the disc space was done.
The epidural fat was absent in the compressed
area and the root was in bad shape.
Routine closure of the wound and smooth
postoperative recovery.
Comments
The patient has pathological process in
the right knee, but considering that the extrusion is a
major one, priority for surgical treatment of the PLD L2-3
was given.
The disc space is shallow, which indicate low recurrence
rate.
The bad shape of the root, could anticipate
bad recovery of this root, but elimination of compression could
yield good result, considering that the other roots were
involved in the process.
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