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
The patient came to the clinic
16-July-2006 complaining right sciatica with hip pain with no
scoliosis for one week. On examination: the motor and sensory
functions were normal. The patient was operated by me
30.April-2006
for huge extrusion of L5-S1 right side. Despite the relatively
acceptable condition of the patient, the patient was asked to
perform check MRI to rule out recurrence. The patient took the
decision to take pain killers and wait. 2 days later the right
sciatica became more severe and the patient performed MRI, which
confirmed the recurrence at the same site. On examination
18-July-2006, the patient was in agonizing pain with inability to
stand with SLRS right 40 degrees and left 50 degrees with weak
dorsiflexion right foot and hypalgesia right S1 territory.
The
patient was operated the next day: right hemiscarotomy L5-S1 was
performed and the recurrence was removed lateral to the axilla.
After that, it was possible to dissect the right S1 root and inspect
the axilla, which proved to be free of fragments. The root was
severely involved with the scar process.
Prompt postoperative recovery and the power of the right foot
became normal.
Comments:
1. The patient
had at the first operation a huge extrusion and "meticulous"
cleaning was performed. It is usually done when the annulus fibrosis
defect is wide from the start. The disc apse at the second
operation was empty, but the disc material which came out and caused
recurrence is mostly the parts of the annulus fibrosis and
underlying external layers of the disc material.
