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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29-APRIL-2008 USAMA MAHMOUD MESLEH 43
YEARS RECURRENT PLD L5-S1 WITH RIGHT HUGE DOWNWARD MIGRATION.
Anamnesis:
The patient came to the
clinic 24-April-2008 complaining of LBP for 45
days with right sciatica. Three days later
progressed minimal left sciatica.
The patient is a known
diabetic for 12 years and hypertensive for 9
years and he underwent discectomy of L5-S1 1989
for right sciatica.
MRI performed 20-April-2008
showed huge recurrent disc L5-S1 with right
downward migration.
On examination: the patient
is limping with scoliotic stance. SLRS was 40 degrees in the
right and 60 degrees in the left with pain.
He had weak dorsi and planterflexion right foot
4/5 with hypalgesia right L5 and S1 territories.
Right S1 foraminotomy and
scarolysis at the previous surgery was
performed. The extruded disc was removed lateral
to the axilla in several pieces. Cleaning of the
disc space was done from the right side.
Routine closure of the wound
with smooth postoperative recovery.
Considerable improvement of the
power of the right foot.
Comments
In diabetic patients we try
to avoid using the electrocautery to
minimize the rate of postoperative infection.
The recurrence happened 19
years after the first surgery in the same side.
The expected recurrence is
low because the disc space is almost empty and
the disc space height is minimal.
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