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22-02-2005 ZAYNAB MUHAMED DARWEESH
56 YEARS PLD L5-S1 WITH DOWNWARD MIGRATION
Anamnesis
A 56 years age lady was complaining of LBP for several years . The
last 8 months started to complain of right sciatica. She came with
severe weak dorsi and planterflexion of all toes right foot with
hypalgesia of the right S1 root and SLRS 15 degrees in the right
side. MRI showed an extruded disc L5-S1 with downward migration to
the right S1 root.
The patient was operated and
right hemiflavotomy with foraminotomy right S1
root done. The extruded disc was hard and
adherent to the root, indicating that it was an
old one. The extrusion was removed from many
angles; from the axilla and lateral to the root.
After removal of the extrusion, it was
impossible to attack the disc space without
removing the calcified elevated part of the
annulus fibrosus, abutting the nerve. Using the
Smith-Kerrison, the hole was widened to remove
the elevation and perform the intradiscal
cleaning. Fat transfer was performed from the
most near parts. This case is a demonstration,
that not always, you can attack the disc space
from the point of extrusion the disc material,
which was in this case below the inferior border
of the annulus fibrosus and it was calcified.
Follow Up
The patient came to the clinic
05-March-2005 with clean wound with mild weak
dorsiflexion both feet with numbness right S1
root.
Comments
The estimated postoperative recurrence is around 7%, because the
disc space is not completely collapsed.
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