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.tv
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20-DECEMBER-2010 FATHI JARAD AL-HALAYQEH 65 YEARS
EXTRUDED DISC L4-5 WITH FAR LEFT DOWNWARD MIGRATION WITH LCS L3-4.
Anamnesis
The patient
came to the clinic 09-December-2010 complaining
of LBP with left sciatica for 2 years with
exacerbation last week.
On
examination: The patient is limping with
exaggerated scoliotic stance. SLRS was 65
degrees in the left with pain. There was weak
dorsi and planterflexion left foot -4/5.
MRI lumbar
spine performed 12-December-2010 showing
extruded disc L4-5 with far downward migration,
reaching the L5-S1 level with stenosis of
L3-4.
Laminectomy of L4 and partial of L3 and L5
performed. Foraminotomy of left L5 root was
achieved. The extruded disc L4-5 was removed
from under the axilla of left L5 root in several
big pieces. The disc space of L4-5 was cleaned
lateral to the axilla. Bilateral flavotomy of
L3-4 was done and all the compressive elements
at this level were eliminated.
Routine
closure of the wound. Smooth postoperative
recovery with normalization of the power of the
left foot.
Comments
The patient has extruded disc
L4-5 with far left downward migration. It was
necessary to perform hemilaminectomy of L5 to
expose the entire migrating piece down.
The lumbar canal stenosis
must be resolved so as to avoid future surgery
for this stenosis.
The estimated recurrence rate
at L4-5 still ranking above 7%, because the disc
space height is still not shallow.
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Notice: Not all operative activities
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