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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

 

The patient  came to the clinic with agonizing pain with right sciatica and severe weak dorsi and planterflexion of the right foot with SLRS right 10 degrees. She was sent for MRI lumbar spine, confirming the presence of huge prolapsed disc L4-5 right side and small bulge L5-S1.

The patient was operated: Right L4-5 hemiflavotomy was performed, and the extruded disc was removed lateral to the axilla and minimal cleaning of the disc space of L4-5 was done. Check of the foramen of left L5 root was negative for presence of compression. Foraminotomy right L5 root was achieved.

During the first steps of surgery, overmobility of the L5 lamina was noted. Inspection for isthmolysis or fatigue fractures were negative. No evidence of spondylolisthesis in the morphological studies were noted. It was decided to achieve good ample for the root in case that the patient in the up-right position could suffer compression or irritation of the root.

Comments:

1. As several times mentioned the PLD rarely coming alone, some associated pathologic findings could be noticed before during and even after surgery. It is hard to predict the importance of these findings, but they must be considered during surgery and the guess of the surgeon to make the appropriate decision, how to deal with such situation, as in this case with overmobility. Only wide foraminotomy of the right L5 root was done by drilling to preserve the bony alignments.

 


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[2005] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved