The patient is a Syrian citizen came to the clinic 20-November-2012 complaining of LBP since 1995 and was diagnosed as having PLD L4-5. The last 6 months he got exacerbation of LBP and cramps of both lower limbs and inability to walk. He is using cysto-fix for 2 years. The patient is in wheelchair for 5 months. He has arterial hypertension for 3 months.

On examination: the patient using wheelchair. Neck and upper limbs are normal. There is complete paraplegia and anaesthesia 10 cm above the inguinal ligament both sides.  SLRS was zero both sides with Babinski positive both sides with gross mass reflexes and spastic pattern both lower limbs. The power of both lower limbs were 0/5 including the iliopsoas muscles.

The patient was sent for MRI of the dorsal and lumbar spine which was done 21-November-2012 which showed huge extruded disc D11-12 with right upward migration with severe segmental stenosis and malacia of the spinal cord at this level with stenosis of D12-L1 level.

Using image-intensifier, decompressive laminectomy of D11and upper half of D12 was done. There was no epidural fat in the area and severe compression by distorted ligamentum flavum from the right side. The right Th11 was severely compressed by the underlying upward migrating extrusion. The laminectomy was extended to the right so as to avoid any traction to the dura. Discectomy of D11-12 was done. The upward right migrating disc was inspected and removed from under the root. 

Routine closure of the wounds. Smooth postoperative recovery. The neurologic deficit is the same as before the surgery.

The patient has complete paraplegia for 5 months. Expectation for recovery is minimal with surgery, but zero or even getting worse without surgery.

Time will show the degree of recovery and it must be boosted with medical therapy.