Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
neurosurgery.fr
04-SEPTEMBER-2009 RASHED ESHEIGH HAMDAN 50 YEARS
RECURRENT PLD L4-5 WITH INFECTION.
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Anamnesis:
The patient was operated
elsewhere 04-August-2009 for right sciatica for
PLD L4-5 which was complicated with infection
and recurrence with agonizing right sciatica.
The patient was operated another time
27-August-2009 after what further deterioration
with drop of the right foot took place.
MRI lumbar spine performed
03-September-2009 showing huge recurrence of
L4-5 with still having infection of the wound.
On examination: the patient
is bedridden and unable to walk due to agonizing
right sciatica.
SLRS was 40 degrees in the right with pain with
complete drop right foot and weak planterflexion
right foot 4/5 and analgesia of right
L5 root and hypalgesia of right S1 root.
The wound was refreshed
and the pus was sent for Bac-Tec. Right L5 foraminotomy with
the use of imageintensifier and the extruded
disc was removed lateral to the axilla in
several
pieces. Meticulous cleaning of the disc space of
L4-5 was achieved from the right. The old scar
tissue was removed to inspect the axilla so as
not to miss migrating material down the axilla.
Inspection of the root in the foramen was
negative. Debridement of the wound with removal
of all infected tissues.
Routine closure of the
wound and smooth
postoperative recovery
and the patient sent to
the ward.
Comments
The patient was operated
twice by fenestration. Using this approach is
not ideal, since you cannot identify the root
and explore the axilla. It was necessary to
extend the flavotomy up and down to see all the
involved structures.
PEEK satellite sphere cannot
be used in this case, because it could trigger
the infection.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
