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
31-AUGUST-2009 NASER IBRAHEEM SALEM 33 YEARS
EXTRUDED DISC L5-S1 WITH RIGHT UP AND DOWNWARD MIGRATION.
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Anamnesis:
The patient came to the
clinic 29-August-2009 complaining of LBP for 2
years with right sciatica for 2 months.
MRI lumbar spine performed
04-June-2009 showing extruded disc L5-S1 right
side.
On examination: the patient
is limping with exaggerated scoliotic stance.
SLRS was 30 degrees in the right with pain with
weak dorsi and planterflexion right foot 4/5.
The patient was sent for new
MRI, which was done 30-August-2009 showing
increase of the extrusion.
Right S1 foraminotomy with
cleaning of the extruded disc material lateral
to the axilla. The disc space was meticulously
cleaned from the right.
Routine closure of the
wound and smooth
postoperative recovery
and the patient sent to
the ward.
Comments
The patient still having disc
space with considerable height and he is young.
The expected recurrence rate in this case could
be ranking higher than 10%.
PEEK satellite sphere was
used to minimize the postoperative recurrence
rate and keep segmental movement at this level.
Postoperative course
The patient still having
scoliotic stance and no sciatica. MRI
performed 18-November-2009 showing no
recurrence, but the sphere is shifted to the
right.
PEEK satellite sphere must be
installed at the center , as it was performed in
this case, but it could migrate off the center
if the patient progressing exaggerated scoliotic
stance. Follow up studies will clarify what is
the cause and what is the result.
Figure-1: The patient scoliotic stance
and radiological findings 2 months after surgery.
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 .
